Nutritional-immunological assessment by CONUT score predicts surgical outcomes in tuberculous empyema: development of a multivariate risk model.

Tuberculous empyema remains a challenging complication of Mycobacterium tuberculosis infection, with high recurrence rates and poor long-term prognosis. This retrospective cohort study evaluated the prognostic utility of the Controlling Nutritional Status (CONUT) score—a composite index integrating serum albumin, total cholesterol, and lymphocyte count—in predicting postoperative recurrence among 325 patients undergoing decortication (87.7% via VATS) at Hangzhou Red Cross Hospital between 2017 and 2024. Univariate analysis identified high CONUT scores (OR = 2.37, 95% CI:1.53–3.71, p < 0.001), elevated CRP, prolonged operative time, and open surgery as significant risk factors. A multivariate nomogram incorporating these variables demonstrated moderate predictive accuracy (AUC = 0.70), with CONUT score outperforming traditional nutritional indices like BMI. The study highlights malnutrition-immunodeficiency interplay in recurrence pathogenesis, advocating for preoperative CONUT-based risk stratification to guide nutritional optimization and surgical planning. Integrating the CONUT score into perioperative assessment may improve stratification, guide targeted interventions, and ultimately enhance surgical outcomes for patients with tuberculous empyema.