Prognostic Impact of Nutritional Status in Patients with Candidemia

Background: Candidemia remains a life-threatening infection with high mortality despite advances in antifungal therapy. Malnutrition has been suggested as an important contributor to poor outcomes; however, the prognostic value of different nutritional assessment tools in candidemia has not been fully clarified. This study aimed to evaluate the impact of nutritional status on prognosis in patients with candidemia and to identify the most reliable nutritional assessment tool. Method: We conducted a retrospective cohort study of adult patients diagnosed with candidemia at a tertiary teaching hospital in Japan between 2014 and 2024. A total of 170 patients were included, with a mean age of 73 years. Nutritional status was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and Controlling Nutritional Status (CONUT) score. The primary outcome was 30-day mortality. Results: According to the GLIM criteria, 72% of patients were classified as malnourished. The 30-day and in-hospital mortality rates were 35% and 44%, respectively. The CONUT score demonstrated good prognostic performance for 30-day mortality (Area under the Receiver operating characteristic 0.723, p < 0.001), with an optimal cut-off value of 12. Patients with higher CONUT scores had significantly shorter overall survival (Log-rank test p < 0.001). In multivariate analysis, a CONUT score ≥ 12, SOFA score ≥ 5, and the European Confederation of Medical Mycology Quality of Clinical Candidemia Management (EQUAL) Candida score ≥ 10 were independent predictors of 30-day mortality, whereas malnutrition defined by the GLIM criteria was not. Conclusions: The CONUT score is a useful prognostic indicator for short-term mortality in patients with candidemia, outperforming the GLIM criteria.