Derivation of the Screening of Nutritional Risk in Intensive Care risk prediction score: A secondary analysis of a prospective cohort study

Abstract

BackgroundFor critically ill patients, the recommended nutritional risk screening tools are the Nutrition Risk in Critically Ill (NUTRIC) and the Nutritional Risk Screening 2002 (NRS‐2002). However, both tools have limitations.ObjectiveThis study aimed to develop a new screening tool, the Screening of Nutritional Risk In Intensive Care (SCREENIC score), and assess its predictive validity.MethodsA secondary analysis of a prospective cohort study was conducted to develop the SCREENIC score. Variables from mNUTRIC, NRS‐2002, Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutritional Risk in Emergency‐2017 (NRE‐2017), Subjective Global Assessment (SGA), and Global Leadership Initiative on Malnutrition (GLIM) were considered. The high nutritional risk cutoff point was defined using mNUTRIC as a reference. Predictive validity was evaluated using logistic regression and COX regression.ResultsThe study included 450 patients (64 [54‐71] years, 52.2% men). The SCREENIC score comprised six questions: 1. Does the patient have > 2 comorbidities? (1.3 points); 2. Was the patient hospitalized for 2 days or more before ICU admission? (0.9 points); 3. Does the patient have sepsis? (1.0 points); 4. Was the patient on mechanical ventilation upon ICU admission? (1.2 points); 5. Is the patient aged above 65 years? (1.2 points); 6. Does the patient exhibit signs of moderate/severe muscle mass loss according to the physical exam? (0.6 points). The high nutritional risk cutoff point was set at 4.0. SCREENIC demonstrated moderate agreement (k=0.564), high accuracy [0.896 (95% CI 0.867‐0.925)], and high sensitivity (88.5%) with mNUTRIC. It independently predicted prolonged ICU stay [OR=1.81 (95% CI 1.14‐2.85)] and hospital stay [OR=2.15 (95% CI 1.37‐3.38)].ConclusionThe SCREENIC score comprises questions with variables that do not require detailed nutritional history. It exhibited moderate agreement, high sensitivity with mNUTRIC, and independent predictive capability. Further evaluation of its applicability, reproducibility, and validity in guiding nutrition therapy is needed using large external cohorts.This article is protected by copyright. All rights reserved.