Use of modified-NUTRIC score to assess nutritional risk in surgical intensive care unit

Abstract

Background: Modified Nutrition Risk in the Critically Ill (m-NUTRIC) score is used to evaluate the nutritional risk of patients in intensive care units (ICUs). This study aimed to investigate whether m-NUTRIC can be used as a predictive factor related to the outcome of patients in surgical ICU (SICU) and to identify which patients will benefit from aggressive nutritional intervention according to the results of m-NUTRIC score. Methods: A total of 205 patients who were admitted to surgical ICU (SICU) with ventilator use for more than 24 hours were enrolled. The m-NUTRIC score data were calculated the day when the patients were admitted to SICU. Patients were divided into two groups according to their m-NUTRIC score: the low-risk group (<5 points, 116 patients) and the high risk group (≥5 points, 89 patients). Results: In this study, a total of 205 patients were enrolled for analysis, including patients in the low-risk group (n = 116) and those in the high risk group (n = 89). The mean duration of ventilator use was 3.6 ± 6.5 days, and average SICU stays for all patients was 5.1 ± 7.4 days. The SICU mortality was significantly higher in the high-risk group (10.3% vs 1.7%). Comparison between survivals and nonsurvivals was carried out, and the data showed that the AKI, Vasopressors, SOFA, APACHE-II, m-NUTRIC score, and shock patient were all significantly associated with higher mortality. The multivariate analysis revealed that acute kidney injury (OR = 13.16; 95% confidence intervals = 3.69–46.92; p < 0.0001) and m-NUTRIC score were independent factors of ICU mortality in these patients. A receiver operating characteristic curve was used to calculate the area under the curve, which was 0.801. The data indicated that high m-NUTRIC score were significantly associated with SICU mortality with the cutoff score > 4 (sensitivity = 90.5%, specificity = 62.3%, p < 0.001). Conclusion: We found in this study that the high m-NUTRIC score is an independent factor of ICU mortality, and m-NUTRIC score can be used as an initial screening tool for nutritional assessment in patients admitted to surgical ICU. Further investigations to evaluate whether the aggressive nutritional intervention would be beneficial in the SICU patients with higher m-NUTRIC score is mandatory.

Identification of ICU Patients with High Nutritional Risk after Abdominal Surgery Using Modified NUTRIC Score and the Association of Energy Adequacy with 90-Day Mortality

“…It is associated with catabolic hormones, cytokines responding to surgical stress, certain environmental factors such as restrictions in food intake, limitations in physical activity, and sedative drugs [ 16 ]. It can provoke the loss of muscle strength, impede wound healing, and increase the rate of infection, which are major contributors to the high risk of morbidity and mortality [ 1 , 11 , 16 , 22 , 23 ]. Moreover, surgical trauma could further increase the energy and protein requirements by creating a hypermetabolic and catabolic state that is commonly observed in post-surgical patients [ 23 ].…”

“…It became a more practical and easier-to-use tool based on the variables that are easily obtained in the critical care setting. Although several studies have validated its diagnostic value as a predictor of malnutrition [ 9 ], the results of these studies were mostly limited to patients receiving only medical treatment [ 10 , 11 , 12 , 13 , 14 ]. In contrast, relatively little information is available for patients who underwent abdominal surgery, despite their having a high risk of malnutrition, which affects the postoperative prognosis.…”

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

“…Although there was no difference in patients requiring mechanical ventilation and time under mechanical ventilation between the low and high nutritional risk groups, all patients classified as having high nutritional risk needed mechanical ventilation, and the median time under mechanical ventilation was greater in this group. In other samples from critically injured patients (surgical and general nonneurological studies), the mNUTRIC score was significantly associated with an increased duration of mechanical ventilation (19)(20)(21)(22). On the other hand, the longer length of stay in the ICU among patients with high nutritional risk agrees with previously reported findings (21,23).…”

“…In other samples from critically injured patients (surgical and general nonneurological studies), the mNUTRIC score was significantly associated with an increased duration of mechanical ventilation (19)(20)(21)(22). On the other hand, the longer length of stay in the ICU among patients with high nutritional risk agrees with previously reported findings (21,23).…”

“…In our study, it was associated with the type of discharge (death or discharge to the hospital ward). From these results, we can infer that patients who fit the high risk nutritional score profile should receive early nutritional intervention to decrease mortality (21,22,24).…”