NUTRIC and Modified NUTRIC are Accurate Predictors of Outcome in End-Stage Liver Disease: A Validation in Critically Ill Patients with Liver Cirrhosis

Abstract

Malnutrition in critically ill patients with cirrhosis is a frequent but often overlooked complication with high prognostic relevance. The Nutrition Risk in Critically ill (NUTRIC) score and its modified variant (mNUTRIC) were established to assess the nutrition risk of intensive care unit patients. Considering the high mortality of cirrhosis in critically ill patients, this study aims to evaluate the discriminative ability of NUTRIC and mNUTRIC to predict outcome. We performed a retro-prospective evaluation in 150 Caucasian cirrhotic patients admitted to our ICU. Comparative prognostic analyses between NUTRIC and mNUTRIC were assessed in 114 patients. On ICU admission, a large proportion of 65% were classified as high NUTRIC (6–10) and 75% were categorized as high mNUTRIC (5–9). High nutritional risk was linked to disease severity and poor outcome. NUTRIC was moderately superior to mNUTRIC in prediction of 28-day mortality (area under curve 0.806 vs. 0.788) as well as 3-month mortality (area under curve 0.839 vs. 0.819). We found a significant association of NUTRIC and mNUTRIC with MELD, CHILD, renal function, interleukin 6 and albumin, but not with body mass index. NUTRIC and mNUTRIC are characterized by high prognostic accuracy in critically ill patients with cirrhosis. NUTRIC revealed a moderate advantage in prognostic ability compared to mNUTRIC.

Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study

“…The mNUTRIC score has not been widely used in China, where has been no large sample studies. Moreover, there is a debate about the cutoff value of the mNUTRIC score [13,14,18]. Our main objective was to validate the mNUTRIC score in a surgical-medical ICU population in China, we also aimed to identify the cut-off point obtained in the mNUTRIC score that presented the best validity parameters for predicting mortality in this population.…”

NUTRIC Score Is Not Superior to mNUTRIC Score in Prediction of Mortality of COVID-19 Patients

“…In the study by Mayr et al of patients with end-stage liver disease, the AUC for prognostic value of the NUTRIC score was 0.806, and for the mNUTRIC score, 0.788. e highest combined sensitivity and specificity was found with a cutoff value of ≥7. Both the scores were determined to perform better than APACHE II (AUC � 0.745) and SOFA (AUC � 0.778) [21]. In the current study, the APACHE II and SOFA scores were higher.…”

“…In a study by Mayr et al, 114 patients with end-stage liver disease were evaluated in respect of NUTRIC and mNUTRIC scores. Age, IL-6, APACHE II score, SOFA score, and mortality rates were determined to be higher in patients with high NUTRIC and mNUTRIC scores compared to those with low scores ( p < 0.001) [ 21 ]. The findings of that study were similar to the current study results.…”

“…The highest combined sensitivity and specificity was found with a cutoff value of ≥7. Both the scores were determined to perform better than APACHE II (AUC = 0.745) and SOFA (AUC = 0.778) [ 21 ]. In the current study, the APACHE II and SOFA scores were higher.…”

Nutritional assessment of patients with aneurysmal subarachnoid hemorrhage using the modified “Nutrition Risk in the Critically ill" score, and its association with outcomes

“…In the current study, although a high mNUTRIC score was associated with a shorter survival curve, this association was not statistically significant. Previous studies and the original description by Rahman et al demonstrated that a high mNUTRIC score was strongly associated with shorter survival curves (7,20,21,25).…”