Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value.

Ming-Hung Tsai,Chien-Heng Shen,Hui-Chun Huang,Chung-Chi Huang,Ming-Chih Hou,Jau-Min Lien,Yun-Shing Peng,Yung-Chang Chen,Cheng-Shyong Wu,Ya-Chung Tian,Ji-Tseng Fang,Fa-Yauh Lee,Chih-Wei Yang

doi:10.3390/nu11092152

Abstract

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care unit (ICU) patients. This retrospective study was conducted to evaluate the prevalence and prognostic significance of nutrition risk in cirrhotic patients with acute gastroesophageal variceal bleeding (GEVB) using mNUTRIC scores computed on admission to the intensive care unit. The major outcome was 6-week mortality. One-hundred-and-thirty-one admissions in 120 patients were analyzed. Thirty-eight percent of cirrhotic patients with acute GEVB were categorized as being at high nutrition risk (a mNUTRIC score of ≥5). There was a significantly progressive increase in mortality associated with the mNUTRIC score (χ2 for trend, p < 0.001). By using the area under a receiver operating characteristic (ROC) curve, the mNUTRIC demonstrated good discriminative power to predict 6-week mortality (AUROC 0.859). In multivariate analysis, the mNUTRIC score was an independent factor associated with 6-week mortality. In conclusion, the mNUTRIC score can serve as a tool to assess nutrition risk in cirrhotic patients with acute GEVB.

Highlights

Critical illness is characterized by inflammation and neuroendocrine stress responses, which lead to catabolic response and deterioration of nutrition status [1]
Between December 2011 and April 2013, cirrhotic patients presenting with acute gastroesophageal variceal bleeding (GEVB) admitted to intensive care unit (ICU) were considered for enrollment in the study
Our study represents the first validation of the modified Nutrition Risk in Critically Ill (mNUTRIC) score in patients with liver cirrhosis

Summary

Introduction

Critical illness is characterized by inflammation and neuroendocrine stress responses, which lead to catabolic response and deterioration of nutrition status [1]. While many risk-stratifying scores exist to assess nutrition risk, few have been designed and validated for ICU patients [5,6,7,8,9]. It is difficult to compare different studies because of various tools and criteria used to define malnutrition. In this regard, heterogeneous groups of ICU patients should be properly risk-stratified to optimize nutrition support. The Nutrition Risk in Critically Ill (NUTRIC) score, a novel risk assessment tool specific for ICU patients, was first proposed [2]. The NUTRIC score incorporates age, severity of disease reflected by the Acute

Methods

Results

Conclusion