Use of nutrition risk in critically ill (NUTRIC) score to assess nutritional risk in mechanically ventilated patients: A prospective observational study

Abstract

Context:Nutritional risk assessment must be done on all critically ill patients. Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. Traditional scoring systems cannot be used for screening in mechanically ventilated (MV) patients because these patients are unable to provide information on their history of food intake and weight loss. The Nutrition Risk in Critically ill (NUTRIC) score is the appropriate nutritional assessment tool in MV patients.Aims:This prospective observational study was conducted to identify the nutritional risk in MV patients using modified NUTRIC (mNUTRIC) score (with the exception of interleukin-6).Patients and Methods:All adult patients admitted to the ICU and required MV for more than 48 h were included in the study. Data were collected on variables required to calculate mNUTRIC score. Patients with mNUTRIC score ≥5 are considered at nutritional risk. Outcome data were collected on ICU length of stay, ventilator-free days, and mortality.Results:A total of 678 MV patients fit into the inclusion criteria. Majority of the patients were male (67%). Mean age of the patients was 55 years. About 288 (42.5%) patients were at high nutritional risk (mNUTRIC score ≥5). Patients with high mNUTRIC score ≥5 had longer mean ICU average length of stay of 9.0 (±4.2) versus 7.8 (±5.8) mean (± standard deviation) days (P < 0.01) and higher mortality 41.4% versus 26.1% (P < 0.0) compared to patients with low NUTRIC score (≤4). High mNUTRIC score (≥5) predicted mortality with area under the curve of 0.582 (95% confidence interval 0.535-0.628).Conclusions:Nearly 42.5% of MV patients admitted to ICU were at nutritional risk, and high mNUTRIC score was associated with increased ICU length of stay and higher mortality.

The association between modified nutrition risk in critically ill score and mortality in geriatric patients

“…They found that the length of hospital stay and mortality rate are higher in patients with higher nutritional risks (mNUTRIC score ≥5) than in patients with lower mNUTRIC scores. We also found a similar correlation between mNUTRIC score and mortality in our study (10).…”

Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations?

“…The NUTRIC score was developed in studies of critically ill patient populations and has been validated in many observational studies from different countries. 11,[14][15][16][17][18][19][20][21][22][23] As IL-6 is not routinely performed in most ICUs in the world, the modified-NUTRIC (mNUTRIC) score without IL-6 was proposed and revalidated. 14 However, one of the major limitations of the NUTRIC/mNUTRIC score is the absence of classical nutrition variables such as recent food intake and weight change.…”

“…The NUTRIC/mNUTRIC score has been shown in various critically ill populations to have good predictive validity for clinical outcomes, although the discriminative ability is of fair level (Table 1). 11,[14][15][16][20][21][22][23] Various observational studies in different populations have also shown that clinical outcomes are modified by nutrition adequacy depending on the risk status of the patients (Table 1). 11,14,[16][17][18][19] The NUTRIC/mNUTRIC score remains to be prospectively tested in a randomized controlled trial.…”

Avaliação de uma ferramenta nutricional como preditor de prognóstico do paciente gravemente enfermo

“…1 Kalaselvan et al, que estudaram apenas pacientes sob ventilação mecânica, encontraram um valor inferior ao nosso: 48,6% dos pacientes admitidos tinham um escore NUTRIC igual ou superior a 5. 10 A média do escore NUTRIC do trabalho de Kalaiselvan foi 4, inferior à média encontrada no estudo original de Heyland et al, que inicialmente validou o escore. 6 A média do nosso escore foi 5,0±1,9.…”

“…O trabalho de Kalaiselvan tinha uma média de SOFA no D1 de 6.7, o de Heyland, de 7, e o nosso de 8,4±4,6. 10,6 Nesse trabalho foi encontrada uma habilidade preditiva do NUTRIC de se relacionar com mortalidade através do ponto de corte de 5,0 (AUC (area under the ROC curve): 0,736; IC 95%: 0,628-0,844). O estudo de Heyland et al encontrou valor semelhante (AUC: 0,783) com o mesmo ponto de corte, analisando mortalidade de 28 dias.…”