Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool

Abstract

IntroductionTo develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU).MethodsA prospective, observational study of patients expected to stay > 24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) < 20, estimated % oral intake in the week prior, weight loss in the last 3 months and serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels. Approximate quintiles of each variable were assigned points based on the strength of their association with 28 day mortality.ResultsA total of 597 patients were enrolled in this study. Based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI, CRP, PCT, estimated percentage oral intake and weight loss. As the score increased, so did mortality rate and duration of mechanical ventilation. Logistic regression demonstrated that nutritional adequacy modifies the association between the score and 28 day mortality (p = 0.01).ConclusionsThis scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy.

Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study

“…High nutritional risk was present in half of the sample. As described in the original study [14,18] in our work NUTRIC score was associated with the target clinical outcomes; it had low positive predictive value (32.7%) and high negative predictive value (88.8%) to predict 28-day mortality. In this study patients at high nutritional risk had higher LOS, fewer days free of MV and increased 28-day mortality.…”

“…The score was calculated with data from the first 24 h after ICU admission. The NUTRC score ranges from zero to nine; a score ≥5 indicates a high nutritional risk [14]. Main outcome was mortality from all causes at 28 days after admission to the ICU; LOS and days without invasive mechanical ventilation (days free of MV) were secondary outcomes.…”

“…Based on the assumption that the nutritional risk is not the same for all critically ill patients, Heyland et al developed and validated the NUTrition Risk in the Critically ill (NUTRIC score), the first nutritional risk assessment tool developed specifically for the ICU population that could identify patients that require more aggressive nutritional support, based on their nutritional risk [14,15]. The conceptual model links patient predictor markers of acute and chronic starvation, acute and chronic inflammation and outcome.…”

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

“…In the CALORIES trial, in both groups, the amount of nutrition delivered was below target but similar to that seen in previous studies in which nutritional targets were also commonly not met. 67,73,74 This suggests that there are substantial practical and organisational obstacles for both routes of feeding. Other research, more recently, has suggested that it is adequacy of protein intake, rather than simply energy intake, which requires to be supported in critical illness.…”

A Different Approach to the Nutritional Therapy in Intensive Care Units: Nutrition Software (ICNUS)

“…The NUTRIC risk assessment score (19) and other tools (20) can possibly identify critically ill patients who benefit the most from the nutritional therapy. Unfortunately, the majority of critically ill patients experience harm because they do not receive adequate nutritional intake (21).…”