Initial development and validation of a novel nutrition risk, sarcopenia, and frailty assessment tool in mechanically ventilated critically ill patients: The NUTRIC‐SF score

Abstract

Background: Nutrition risk, sarcopenia, and frailty are interrelated. They may be due to suboptimal or prevented by optimal nutrition intake. The combination of nutrition risk (modified nutrition risk in the critically ill [mNUTRIC]), sarcopenia (SARC-F combined with calf circumference [SARC-CALF]), and frailty (clinical frailty scale [CFS]) in a single score may better predict adverse outcomes and prioritize resources for optimal nutrition in the intensive care unit (ICU) Methods: This is a retrospective analysis of a single-center prospective observational study that enrolled mechanically ventilated adults with expected ≥96 h of ICU stay. SARC-F and CFS questionnaires were administered to patient's next-of-kin and mNU-TRIC were calculated. Right calf circumference was measured. Nutrition data were collected from nursing record. The high-risk scores (mNUTRIC ≥ 5, SARC-CALF > 10, or CFS ≥ 4) of these variables were combined to become the nutrition risk, sarcopenia, and frailty (NUTRIC-SF) score (range: 0-3).Results: Eighty-eight patients were analyzed. Increasing mNUTRIC was independently associated with 60-day mortality, whereas increasing SARC-CALF and CFS showed a strong trend towards a higher 60-day mortality. Discriminative ability of NUTRIC-SF for 60-day mortality is better than its component (C-statistics, 0.722; 95% confidence interval [CI], 0.677-0.868). Every increment of 300 kcal/day and 30 g/day is associated with a trend towards higher rate of discharge alive for high (≥2; adjusted hazard ratio, 1.453 [95% CI, 0.991-2.130] for energy; 1.503 [0.936-2.413] for protein) but not low (<2) NUTRIC-SF score. Conclusion:NUTRIC-SF may be a clinically relevant risk stratification tool in the ICU.

Evaluation of bone mineral density and body compositions interrelation in young and middle-aged male patients with Crohn’s disease by quantitative computed tomography

“…In addition, our results also showed an important aspect that the area of LM on the abdomen and muscle mass around the lumbar vertebrae was significantly reduced in CD patients compared to normal contrast after adjusting for the BMI. Depletion of lean body mass is associated with lower quality of life, and higher morbidity and mortality commonly occur as part of the aging process (2,23). At the same time, loss of muscle mass accelerated the BMD reduction.…”

“…LM exerts an additional influence on the skeleton through regional muscle pull and contributes to the loading of the bone. Other possible mechanism is that these disorders are also a characteristic of malnutrition and chronic intestinal inflammation in CD (2). Moreover, it has been shown that increased muscle mass contributed to the increase in BMD and can reduce the vertebral fracture risk (25).…”

“…Over the last two decades, there has been a substantial increase in inflammatory bowel disease (IBD) worldwide, especially Crohn's disease (CD) (1,2). CD is a chronic inflammatory disease of the gastrointestinal tract that can affect many other organ systems, including the musculoskeletal (3).…”

Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality

“…Similar to the proposed mNUTRIC-S2 score of this study, the NUTRIC-SF score (which combines the modified NUTRIC score with a measure of sarcopenia and frailty) [ 27 ], the NUTRIC-S score (which uses SAPS III instead of APACHE II) [ 28 ], the NUTRIC score, and CRP [ 29 ] are other versions of critical nutritional risk assessment tools, in addition to the NUTRIC and mNUTRIC scores. First, the NUTRIC-SF score is better than the mNUTRIC score, the SARC-CALF (a measure of sarcopenia risk combined with calf circumference), and the Clinical Frailty Scale alone in predicting and discriminating 60-day outcomes [ 27 ]. Second, the NUTRIC-S score (S as a reference to SAPS III) was recently proposed.…”

Identification of ICU Patients with High Nutritional Risk after Abdominal Surgery Using Modified NUTRIC Score and the Association of Energy Adequacy with 90-Day Mortality

“…It became a more practical and easier-to-use tool based on the variables that are easily obtained in the critical care setting. Although several studies have validated its diagnostic value as a predictor of malnutrition [ 9 ], the results of these studies were mostly limited to patients receiving only medical treatment [ 10 , 11 , 12 , 13 , 14 ]. In contrast, relatively little information is available for patients who underwent abdominal surgery, despite their having a high risk of malnutrition, which affects the postoperative prognosis.…”