NUTRIC-S proposal: Using SAPS 3 for mortality prediction in nutritional risk ICU patients

Toledo, Diogo Oliveira; Silva, João Manoel da; Toloi, Jerusa Márcia; Assis, Thaisa de; Serra, Luciana Martins; Carmo, Paula Glaucieli do; Pfeilsticker, Flavia Julie do Amaral; Santos, Dyaiane Marques dos; Freitas, Branca Jardini de; Oliveira, Amanda M.R. de; Heyland, Daren K.

doi:10.1016/j.yclnex.2019.12.003

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…publication with 1199 patients [4] and 0.66 in Mendes et al' publication with 1143 patients [5]) and a similar publication from Brazil (0.62 in Toledo et al' publication) [21].…”

Section: Plos Onementioning

confidence: 74%

“…If our results are applicable to younger patients remains to be demonstrated. Nevertheless, Toledo et al demonstrated similar findings in a younger population (mean age of 63) [21]. Finally, functional and health-related quality of life measures would be one of the most relevant outcomes in nutrition studies, but usually are secondary outcomes in large randomized controlled trials [30].…”

Section: Plos Onementioning

confidence: 93%

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Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3

Souza

Ribeiro

Jonckheer³

et al. 2022

PLoS ONE

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Objectives The Nutrition Risk in the Critically Ill (NUTRIC) score has been advocated as a screening tool for nutrition risk assessment in critically ill patients. It was developed and validated to predict 28-day mortality using Acute Physiology and Chronic Health Evaluation II (APACHE II) score as one of its components. However, nowadays the Simplified Acute Physiology Score 3 (SAPS 3) demonstrates better performance. We aimed to test the performance of NUTRIC score in predicting 28-day mortality after replacement of APACHE II by SAPS 3, and the interaction between nutrition adequacy and mortality. Methods Adult patients who received nutrition therapy and remained >3 days in intensive care unit were retrospectively evaluated. In order to replace APACHE II component, we used ranges of SAPS 3 with similar predicted mortality. Discrimination between these tools in predicting 28-day mortality was assessed using the ROC curve, calibration was evaluated with calibration belt, and correlation with intraclass correlation. The relationship between nutritional adequacy and mortality was assessed in a subgroup with available data. Results 542 patients were analyzed (median age of 78 years old, 73.4% admitted for non-surgical reasons and 28-day mortality was 18.1%). Mortality prediction discrimination did not differ between tools (p>0.05), but showed a good agreement (intraclass correlation 0.86) with good calibration. In the subgroup analysis for nutritional adequacy (n = 99), no association with mortality was observed. Conclusion Performance of NUTRIC score with SAPS 3 is similar to the original tool. Therefore, it might be used in settings where APACHE II is not available.

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“…publication with 1199 patients [4] and 0.66 in Mendes et al' publication with 1143 patients [5]) and a similar publication from Brazil (0.62 in Toledo et al' publication) [21].…”

Section: Plos Onementioning

confidence: 74%

Section: Plos Onementioning

confidence: 93%

Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3

Souza

Ribeiro

Jonckheer³

et al. 2022

PLoS ONE

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“…The NUTRIC-S score that replaced the APACHE II with SAPS III score may be also useful but additional studies are needed to validate the NUTRIC-S for the NUTRIC-SF score. 34 Furthermore, we did not test the association between combined nutrition and exercise intervention with the NUTRIC-SF score. In a recent randomized controlled trial, higher vs lower protein delivery (∼1.5 vs 0.8 g/kg/day) was associated with significantly less femoral muscle volume loss and this effect was only evident with early rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…One barrier in calculating the mNUTRIC is that not all ICU assess the APACHE II score. The NUTRIC‐S score that replaced the APACHE II with SAPS III score may be also useful but additional studies are needed to validate the NUTRIC‐S for the NUTRIC‐SF score 34 …”

Section: Discussionmentioning

confidence: 99%

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

Lee

Hasan

Day

et al. 2021

J Parenter Enteral Nutr

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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.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background: Nutritional status is associated with mortality. The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is one of the most commonly used nutritional risk assessment tools in intensive care units (ICUs). The purpose of this study was to compare the mortality predictive ability of the mNUTRIC score to that of the mNUTRIC-S2 score, which uses the Simplified Acute Physiology Score (SAPS) II instead of the Acute Physiology and Chronic Health Evaluation (APACHE) II. Methods: This retrospective cohort analysis included patients admitted to the ICU between January and September 2020. Each patient's electronic medical records were reviewed. The model discrimination for predicting ICU mortality was assessed by the area under the receiver operating characteristic (ROC) curve, and a Cox regression model was performed to confirm the relationship between the groups and mortality. Results: In total, 220 patients were enrolled. The ROC curve for predicting ICU mortality was 0.64 for the mNUTRIC score versus 0.67 for the mNUTRIC-S2 score. The difference between the areas was 0.03 (95% confidence interval [CI], -0.01 to 0.06; P=0.09). Patients with mNUTRIC-S2 score ≥5 had a greater risk of ICU mortality (hazard ratio [HR], 3.64; 95% CI, 1.85-7.14, P<0.001); however, no such relationship was observed with mNUTRIC score (HR, 1.69; 95% CI, 0.62-4.62; P=0.31). Conclusions:The mNUTRIC-S2 score was significantly associated with ICU mortality. A cutoff score of 5 was selected as most appropriate.

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NUTRIC-S proposal: Using SAPS 3 for mortality prediction in nutritional risk ICU patients

Cited by 8 publications

References 21 publications

Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3

Performance of NUTRIC score to predict 28-day mortality in critically ill patients after replacing APACHE II with SAPS 3

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

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

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