Myosteatosis is associated with adverse in-hospital outcomes and CONUT score in hospitalized internal medicine patients

Aims: Myosteatosis is a marker of malnutrition and of adverse clinical outcomes and diabetes is among its contributors. Currently, no single universally accepted method exists to screen for malnutrition, but COntrolling NUTritional status (CONUT) score seems to be promising. This study aimed to assess the impact of myosteatosis on in-hospital outcomes and to test its association with CONUT score in people with and without type 2 diabetes. Methods: 227 patients aged > 40 years admitted to an Internal Medicine Department were consecutively recruited, recording in-hospital outcomes. Myosteatosis was assessed as multifidus muscle to subcutaneous fat (MM/F) attenuation ratio at computed-tomography scan. CONUT was calculated using albumin, lymphocyte count and total cholesterol. The population was stratified, based on sex-differentiated tertiles of MM/F, in a low myosteatosis group (n = 152) and a high myosteatosis group (n = 75; top tertile of MM/F). Results: The high myosteatosis group showed a higher prevalence of in-hospital death (12.5 vs. 26%, P < 0.001) and pneumonia. Moreover, the high myosteatosis group experienced a longer length-of-stay and was more likely to have cultures positive for multi-drug-resistant germs. In-hospital death was independently associated with MM/F ratio (OR 2.74, 95%CI 1.11–7.75, P = 0.035). Diabetes did not show significant interaction on this association (P-for-interaction = 0.43). From multiple regression model, MM/F was independently associated with CONUT (β = 0.30, P < 0.001). Conclusions: Myosteatosis was associated with adverse in-hospital outcomes. CONUT score was independently associated with the imaging-derived MM/F ratio. Further studies specifically designed to evaluate diagnostic performance are required before CONUT can be proposed as a screening tool for myosteatosis.