Nutritional risk in critically ill patients: how it is assessed, its prevalence and prognostic value: a systematic review

Abstract

Context Nutritional risk (NR) screening is the first step of nutrition care process. Few data are available in literature about its prevalence, nor, to our knowledge, is a universally accepted reference method for the intensive care unit (ICU). Objective The aim for this systematic review was to summarize evidence regarding the prevalence of NR and the predictive validity of different tools applied for NR screening of critically ill patients. Data Sources The PubMed, Embase, and Scopus databases were searched up to December 2019 using the subject headings related to critically ill patients and NR screening. The current systematic review is registered with PROSPERO (identifier: CRD42019129668). Data Extraction Data on NR prevalence, predictive validity of nutritional screening tools, and interaction between caloric-protein balance and NR in outcome prediction were collected. Data Analysis Results were summarized qualitatively in text and tables, considering the outcomes of interest. Results From 15 669 articles initially identified, 36 fulfilled the inclusion criteria, providing data from 8 nutritional screening tools: modified Nutrition Risk in the Critically Ill (mNUTRIC; n = 26 studies) and Nutritional Risk Screening–2002 (NRS-2002; n = 7 studies) were the most frequent; the NR prevalence was 55.9% (range, 16.0% to 99.5%). Nutritional risk was a predictor of 28-day and ICU mortality in 8 studies. Interactions between caloric-protein balance and NR on outcome prediction presented were scarcely tested and presented heterogeneous results (n = 8). Conclusions Prevalence of NR in patients in the ICU varies widely; a satisfactory predictive validity was observed, especially when mNUTRIC or NRS-2002 were applied.

The prognostic value of modified NUTRIC score for patients in cardiothoracic surgery recovery unit: A retrospective cohort study

“…NUTRIC score and NRS 2002 demonstrated inconsistent predictive value in different types of patients. Although the mNUTRIC score was reported in some previous studies, patients in most of them were mixed or medical ICU 32 . The present study is the first to explore the value of the mNUTRIC score in CSRU.…”

“…31 previous studies, patients in most of them were mixed or medical ICU. 32 The present study is the first to explore the value of the mNUTRIC score in CSRU. Based on a large population, the mNUTRIC score was found to be a predictive factor of hospital mortality and a prognostic factor of OS at of 365 and 1000 days .…”

Albumin–Globulin Ratio Is an Independent Determinant of 28-Day Mortality in Patients with Critical Illness

“…Therefore, nutritional status was associated with the prognosis of critically ill patients. Nutritional risk has been proven to be a predictor of 28-day and ICU mortality [ 12 ]. Many studies have focused on nutrition status and its predictable role in critically ill patients, as well as nutrition therapy [ 13 , 14 ].…”

Critical deficiencies of energy and protein with a high provision of non-nutritional calories after one week in an intensive care unit

“…De acuerdo con los resultados del cribado NRS-2002 (> 5), un 80,8 % de los pacientes estaban en RD a su ingreso. Este hallazgo queda en el rango del 39,4 % a 99,5 % publicado en una revisión sistemática (20).…”

“…En el presente estudio, solo 6 (23 %) sujetos mostraron RD al evaluarlos con el cribado NUTRIC con IL-6. Dicha proporción queda más bien en la parte baja del rango de prevalencia del RD, del 16 % al 91,1 %, encontrado aplicando el mismo cribado (20), aunque solo 2 estudios de los analizados habían incluido la IL-6. Por el tipo de parámetros involucrados, el cribado NUTRIC se asocia más a la predicción de la mortalidad que al RD, especialmente cuando se incluyen los valores de IL-6 (21).…”