Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool

Rahman, Ashrafur; Hasan, Rana M.; Agarwala, Ravi; Martin, Claudio M.; Day, Andrew G.; Heyland, Daren K.

doi:10.1016/j.clnu.2015.01.015

Cited by 388 publications

(451 citation statements)

References 13 publications

Supporting

Mentioning

375

Contrasting

Unclassified

Order By: Relevance

“…The 28-day mortality in this Portuguese national sample (21.7%) is similar to that of the original validation of the NUTRIC score (23.1%) [14] but it is lower than that observed in the second validation of the score (29%) [18]. The AUC is significantly higher in the original validation study but in both studies it is classified as "adequate".…”

Section: Discussionmentioning

confidence: 51%

“…In this study patients at high nutritional risk had higher LOS, fewer days free of MV and increased 28-day mortality. The mean NUTRIC score in our study (4.4) is slightly (but not significantly) lower than that of the original validation of the NUTRIC score (4.7) [14] though clearly lower than that of the second validation of the score (5.5) [18]. The participants in this Portuguese (national) sample show significant differences on the variables included in the NUTRIC score when compared to the original validation group [14].…”

Section: Discussionmentioning

confidence: 55%

“…High nutritional risk was present in half of the sample. As described in the original study [14,18] in our work NUTRIC score was associated with the target clinical outcomes; it had low positive predictive value (32.7%) and high negative predictive value (88.8%) to predict 28-day mortality. In this study patients at high nutritional risk had higher LOS, fewer days free of MV and increased 28-day mortality.…”

Section: Discussionmentioning

confidence: 99%

“…As it has already been demonstrated, the performance of the NUTRIC score varies only slightly when excluding IL-6 levels from the score or when this is replaced by another available inflammatory biomarker. The modified NUTRIC score (without IL-6) has been recently validated [18].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study

Mendes

Policarpo²,

Fortuna

et al. 2017

Journal of Critical Care

Self Cite

View full text Add to dashboard Cite

a b s t r a c t a r t i c l e i n f o Keywords:Critically ill Nutritional risk Modified NUTRIC score Effectiveness Cultural validation Purpose: Characterize the nutritional risk of critically ill patients with the modified NUTrition Risk in the Critically ill (NUTRIC) score. Materials: National, multicenter, prospective, observational study conducted in 15 polyvalent Portuguese intensive care unit (ICU), during 6 months. Adult patients were eligible. Those transferred from another ICU or readmitted, brain dead at admission, and with length of ICU stay (LOS) of 72 hours or less were excluded. NUTRIC score was calculated at admission; scores ≥5 represent a high nutritional risk. Main outcome was mortality from all causes at 28 days after admission to the ICU; LOS and days without mechanical ventilation (days free of MV) were secondary outcomes. Results: From 2061 admissions, 1143 patients were considered, mostly males (n = 744, 64.7%) with median (P 25 -P 75 ) age of 64 (51-75). Patients at high nutritional risk were 555 (48.6%). High NUTRIC score was associated with longer LOS (P b .001), less days free of MV (P = .002) and higher 28-day mortality (P b .001). The area under the curve of NUTRIC score ≥5 for predicting 28-day mortality was 0.658 (95% CI, 0.620-0.696). NUTRIC score ≥5 had a positive predictive value 32.7% and a negative predictive value 88.8% for 28-day mortality. Conclusions: Almost half of the patients in Portuguese ICUs are at high nutritional risk. NUTRIC score was strongly associated with main clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study

Mendes

Policarpo²,

Fortuna

et al. 2017

Journal of Critical Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the CALORIES trial, in both groups, the amount of nutrition delivered was below target but similar to that seen in previous studies in which nutritional targets were also commonly not met. 67,73,74 This suggests that there are substantial practical and organisational obstacles for both routes of feeding. Other research, more recently, has suggested that it is adequacy of protein intake, rather than simply energy intake, which requires to be supported in critical illness.…”

Section: Results In Contextmentioning

confidence: 99%

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Harvey

Parrott

Harrison

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundMalnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery.ObjectivesTo estimate the effect of early nutritional support via the parenteral route compared with the enteral route on mortality at 30 days and on incremental cost-effectiveness at 1 year. Secondary objectives were to compare the route of early nutritional support on duration of organ support; infectious and non-infectious complications; critical care unit and acute hospital length of stay; all-cause mortality at critical care unit and acute hospital discharge, at 90 days and 1 year; survival to 90 days and 1 year; nutritional and health-related quality of life, resource use and costs at 90 days and 1 year; and estimated lifetime incremental cost-effectiveness.DesignA pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation.SettingAdult general critical care units in 33 NHS hospitals in England.Participants2400 eligible patients.InterventionsFive days of early nutritional support delivered via the parenteral (n = 1200) and enteral (n = 1200) route.Main outcome measuresAll-cause mortality at 30 days after randomisation and incremental net benefit (INB) (at £20,000 per quality-adjusted life-year) at 1 year.ResultsBy 30 days, 393 of 1188 (33.1%) patients assigned to receive early nutritional support via the parenteral route and 409 of 1195 (34.2%) assigned to the enteral route had died [p = 0.57; absolute risk reduction 1.15%, 95% confidence interval (CI) −2.65 to 4.94; relative risk 0.97 (0.86 to 1.08)]. At 1 year, INB for the parenteral route compared with the enteral route was negative at −£1320 (95% CI −£3709 to £1069). The probability that early nutritional support via the parenteral route is more cost-effective – given the data – is < 20%. The proportion of patients in the parenteral group who experienced episodes of hypoglycaemia (p = 0.006) and of vomiting (p < 0.001) was significantly lower than in the enteral group. There were no significant differences in the 15 other secondary outcomes and no significant interactions with pre-specified subgroups.LimitationsBlinding of nutritional support was deemed to be impractical and, although the primary outcome was objective, some secondary outcomes, although defined and objectively assessed, may have been more vulnerable to observer bias.ConclusionsThere was no significant difference in all-cause mortality at 30 days for early nutritional support via the parenteral route compared with the enteral route among adults admitted to critical care units in England. On average, costs were higher for the parenteral route, which, combined with similar survival and quality of life, resulted in negative INBs at 1 year.Future workNutritional support is a complex combination of timing, dose, duration, delivery and type, all of which may affect outcomes and costs. Conflicting evidence remains regarding optimum provision to critically ill patients. There is a need to utilise rigorous consensus methods to establish future priorities for basic and clinical research in this area.Trial registrationCurrent Controlled Trials ISRCTN17386141.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 28. See the NIHR Journals Library website for further project information.

show abstract

Nutrition support in critical care

Wandrag

Bear

2018

Advanced Nutrition and Dietetics in Nutrition Support

View full text Add to dashboard Cite

Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool

Cited by 388 publications

References 13 publications

Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study

Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Nutrition support in critical care

Contact Info

Product

Resources

About