The relationship between controlling nutritional status (CONUT) and cerebrovascular stenosis: a retrospective study with implications for ischemic stroke prevention

Background Ischemic stroke, a major global health concern, has high incidence, mortality, and disability rates. Cerebrovascular stenosis, a significant risk factor, is often assessed using digital subtraction angiography (DSA), which is invasive and costly. The Controlling Nutritional Status (CONUT) score, originally designed to assess malnutrition, has potential value in predicting vascular stenosis and stroke prognosis. Methods This study analyzed 1,057 inpatients from Xi’an Central Hospital and Tongchuan Mining Bureau Central Hospital who underwent DSA for cerebrovascular stenosis from January 2016 to June 2024, comparing 674 patients with stenosis to 383 without. The CONUT score, calculated from serum albumin, lymphocyte count, and total cholesterol, was evaluated for its association with stenosis severity. Statistical analyses included t-tests, Mann-Whitney U tests, chi-square tests, Spearman correlation, stepwise regression, and ROC curve analysis, and age/comorbidity subgroup analyses. Results CONUT scores were significantly higher in stenosis vs. controls (median 2 vs. 0, p < 0.001) and correlated with stenosis severity (Spearman’s ρ = 0.68, p < 0.001). Each 1-point CONUT increase elevated stenosis risk by 115% (OR = 2.15, 95% CI [1.89–2.47], p < 0.001), persisting after full adjustment for confounders. The score demonstrated moderate diagnostic accuracy (AUC = 0.794), with a sensitivity of 82.3% and a specificity of 76.1% at the optimal cutoff (CONUT score ≥ 5). outperforming traditional risk factors (age, diabetes, low density liproprotein cholesterol (LDL-C); all area under the curve (AUC) < 0.62). Subgroup analysis revealed enhanced predictive efficacy in adults >70 years (OR = 3.15) versus <50 years (OR = 1.82; interaction p = 0.012). Conclusion The CONUT score is an independent predictor of cerebrovascular stenosis severity, with particular utility in elderly populations. It provides a practical, non-invasive tool for preliminary stenosis screening, potentially reducing unnecessary DSA referrals.