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

Abstract

Background Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The modified nutrition risk in the critically ill score (mNUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients, but it has not been fully demonstrated and widely used. Our study was conducted to identify the nutritional risk in ICU patients using the mNUTRIC score and explore the relationship between 28-day mortality and high mNUTRIC scores. Methods This study is a secondary analysis, the data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. We divided the study population into high nutritional risk (mNUTRIC score ≥ 5 points) and low nutritional risk (mNUTRIC score < 5 points) groups. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis, appropriate cut-off was identified by highest combined sensitivity and specificity using Youden’s index. The significance level was set at 5%. Results Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, high nutritional risk patients were older (P < 0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740–0.786). According to Youden’s index, we found a suitable cut-off > 4 for the mNUTRIC score to predict the 28-day mortality. Conclusions Patients admitted to the ICU were at high risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality. More large prospective studies are needed to demonstrate the validity of this score. Trial registration This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.

Prognostic significance of malnutrition risk in elderly patients with acute kidney injury in the intensive care unit

“…Nutritional support methods were based on the guidelines for enteral and parenteral nutrition issued by the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) [ 19 ]. See our published article for details [ 12 ].…”

“…Nutritional risk is low when the mNUTRIC score is 0 ~ 4, and high when the mNUTRIC score is 5 ~ 9 [ 8 , 9 ]. The mNUTRIC score is related to adverse clinical outcomes (death and long duration of mechanical ventilation) [ 9 – 12 ].…”

Significance of the Modified NUTRIC Score for Predicting Clinical Outcomes in Patients with Severe Community-Acquired Pneumonia

“…The mNUTRIC score is an effective tool for detecting malnutrition among ICU patients, as previously reported [ 54 ]. Malnutrition status in the ICU is linked with inflammation and a hypermetabolic state and may further result in decreased immunity, muscle wasting, poor wound healing, and deteriorating infectious processes [ 55 ].…”

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

“…Perhaps, to achieve greater accuracy in this specific population, it is necessary to incorporate neurological prognostic score scales into the variables analyzed by the mNUTRIC score. In other profiles of critically ill patients, mNUTRIC scores are helpful in assessing nutritional risk as well as general outcomes (7,26,27).…”