Prognostic value of different cut-off points of the NRS-2002 tool to identify nutritional risk in critically ill patients: a longitudinal study

Abstract

The American Society of Parenteral and Enteral Nutrition recommends nutritional risk (NR) screening in critically ill patients with NRS-2002 ≥ 3 as NR and ≥ 5 as high NR. The present study aimed to evaluate the predictive validity of different cut-off points of the NRS-2002 in the intensive care unit (ICU). A prospective cohort study was conducted with critically ill adult patients who were screened using the NRS-2002. Hospital and ICU length of stay (LOS), hospital and ICU mortality, and ICU readmission were evaluated as outcomes. Logistic and Cox regression analyses were performed to evaluate the prognostic value of NRS-2002, and an ROC curve was constructed to determine the best cut-off point for NRS-2002. A total of 374 patients (61.9±14.3 years, 51.1% males) were included in the study. Of these, 13.1% were classified as without NR, whereas 48.9% and 38.0% were classified as NR and high NR, respectively. An NRS-2002 score of ≥ 5 was associated with prolonged hospital LOS. The best cut-off point for NRS-2002 was a score ≥ 4, which was associated with prolonged hospital LOS (OR=2.13; 95% CI: 1.39–3.28), ICU readmission (OR=2.44; 95% CI: 1.14–5.22), ICU admission (HR=2.91; 95% CI: 1.47–5.78), and hospital mortality (HR=2.01; 95% CI: 1.24–3.25), but not with ICU prolonged LOS (p=0.688). Therefore, NRS-2002 ≥ 4 presented the most satisfactory predictive validity and should be considered for NR screening in the ICU setting. Future studies should confirm the cut-off point and its validity in predicting nutrition therapy interaction with outcomes.

Complementarity of nutrition screening with Global Leadership Initiative on Malnutrition criteria for diagnosing malnutrition in critically ill patients: A comparison study of Nutritional Risk Screening 2002 and modified Nutrition Risk in the Critically Ill Score

“…We applied the NRS‐2002 cutoff points by ASPEN 2 : scores ≥3 (NRS‐2002_3) and ≥5 (NRS‐2002_5) classified patients as at NR and high NR, respectively. Additionally, we considered the cutoff point established by Stello et al, 15 classifying patients with ≥4 (NRS‐2002_4) as at NR.…”

“…The best cutoff for NRS-2002 in this context is likely ≥4, based on a previous study by our research group, which showed superior prognostic value compared with other cutoff points (≥3 and ≥5). 15…”

“…We hypothesized that NRS‐2002 has better complementarity than mNUTRIC to GLIM criteria for malnutrition diagnosis since NRS‐2002 includes nutrition indicators, whereas they are not part of mNUTRIC. The best cutoff for NRS‐2002 in this context is likely ≥4, based on a previous study by our research group, which showed superior prognostic value compared with other cutoff points (≥3 and ≥5) 15 …”