Identifying the critically ill cirrhotics who benefit the most from nutrition therapy: The mNUTRIC score study

Abstract

Background Malnutrition increases risk of mortality in critically ill cirrhotics. Modified Nutrition Risk in Critically ill (mNUTRIC) score is a validated tool to identify patients at nutrition risk that may benefit the most from goal directed nutrition therapy. We aimed to study the association between mNUTRIC score and 28-day mortality and its modulation by nutritional adequacy in critically ill cirrhotics. Methods A prospective study in critically ill adult cirrhotics was designed with collection of baseline and follow-up data pertaining to mNUTRIC score, clinical, hemodynamic, biochemical, nutritional parameters, use of mechanical ventilation (MV), length of ICU stay, and development of new onset infection (NOI). Daily nutritional adequacy was calculated as percentage of prescribed energy and protein received. Results 150 cirrhotics [(males-83%, age-51 ± 12.1 years, BMI-24 ± 4.7kg/m2; median LOS 6 (2–24 days)] were enrolled. At ICU admission 116 (77%) had high NUTRIC Score (HNS) and 34 (23%) low NUTRIC score (LNS). Patients with HNS had significantly higher mortality [54% vs. 10%; p = 0.008; OR(95%CI) adjusted 3.0(1.39,6.9;p = 0.006)] for etiology and blood sugar ; longer MV days [5(2–24) vs. 3(1–24) ; p = 0.02]; and high incidence of NOI [32% vs. 2.6%; p = 0.002; OR(95% CI:7(2,24.5)] compared to LNS. A logistic regression analysis for interaction of nutritional adequacy and 28 day survival revealed that the probability of survival increases with increase in nutritional adequacy (p < 0.01) in patients with HNS. Conclusion mNUTRIC score is a useful tool in recognizing nutrition risk in critically ill cirrhotics and goal directed nutrition therapy; especially in patients with high mNUTRIC score can significantly improve survival.