Targeted Energy Intake Is the Important Determinant of Clinical Outcomes in Medical Critically Ill Patients with High Nutrition Risk

Abstract

The clinical conditions of critically ill patients are highly heterogeneous; therefore, nutrient requirements should be personalized based on the patient’s nutritional status. However, nutritional status is not always considered when evaluating a patient’s nutritional therapy in the medical intensive care unit (ICU). We conducted a retrospective cross-sectional study to assess the effect of ICU patients’ nutrition risk status on the association between energy intake and clinical outcomes (i.e., hospital, 14-day and 28-day mortality). The nutrition risk of critically ill patients was classified as either high- or low-nutrition risk using the modified Nutrition Risk in the Critically Ill score. There were 559 (75.3%) patients in the high nutrition risk group, while 183 patients were in the low nutrition risk group. Higher mean energy intake was associated with lower hospital, 14-day and 28-day mortality rates in patients with high nutrition risk; while there were no significant associations between mean energy intake and clinical outcomes in patients with low nutrition risk. Further examination of the association between amount of energy intake and clinical outcomes showed that patients with high nutrition risk who consumed at least 800 kcal/day had significantly lower hospital, 14-day and 28-day mortality rates. Although patients with low nutrition risk did not benefit from high energy intake, patients with high nutrition risk are suggested to consume at least 800 kcal/day in order to reduce their mortality rate in the medical ICU.

Modified NUTRIC score and outcomes in critically ill patients: A meta-analysis

“…One study [8] among the three excluded articles reported the full NUTRIC score, not the mNUTRIC score. Therefore, eight studies were considered eligible for inclusion in the current meta-analysis [14][15][16][17][18][19][20][21]. Figure 1 is the flow diagram that outlines the search process, the included and excluded articles, and the causes of exclusion.…”

“…They were published between 2017 and 2019, contained a total of 4076 patients (mean sample size = 509.5; range: 75-1143 patients). Two studies were multi-center [14,20], while the other six were conducted in a single center [15][16][17][18][19]21]. Table 2 shows the number of patients with high and low mNUTRIC score included in each study, their gender, and age.…”

“…Table 2 shows the number of patients with high and low mNUTRIC score included in each study, their gender, and age. Three studies reported the lack of statistically significant difference between high and low mNUTRIC score regarding the patients' gender [16,18,20]. Four studies found that patients with high mNUTRIC score had a significantly higher mean/median age than those with low mNUTRIC score [15,16,18,20].…”

“…Five out of the eight included studies assessed the 28-day mortality using the risk ratio and risk difference [15][16][17]20,21]. The total number of patients with high mNUTRIC score in these five studies was 1119 and death was encountered in 347, while the total number of patients with low mNUTRIC score was 857 and death occurred in 160 patients.…”

“…Four out of the eight included studies assessed the length of ICU stay [15,17,18,20], as shown in Table 5 and Figure 3. The heterogeneity test for the four studies was statistically significant [I 2 = 93.52%; Q (df = 2) = 46.323; p < 0.001].…”