NUTRIC Score Research Articles

Use of Nutrition Risk in Critically Ill (NUTRIC) Scoring System for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Neurological Patients: A Prospective Observational Study.

Critically ill patients who are hospitalized in a neurological intensive care unit (NICU) are largely susceptible to nutrition risk. However, only a limited number of studies have investigated the applicable assessment tool in NICUs. This was a prospective observational study conducted at a single-center NICU. A total of 140 adult patients who were hospitalized for >24 hours were enrolled. The Nutritional Risk Screening 2002, Nutrition Risk in the Critically ill (NUTRIC), and modified NUTRIC (mNUTRIC) scores were applied for the assessment of nutrition risk. Analyses of multivariable logistic regression were performed by considering a 28-day mortality as the outcome of interest. Nutrition risk was commonly identified in NICU patients. Multivariate analysis revealed that age ≥60 years, hospital infection, mechanical ventilation, and high nutrition risk (mNUTRIC score ≥ 5) independently increased 28-day mortality in NICU patients. For subgroups of patients with a prolonged length of stay, high nutrition risk (mNUTRIC score ≥ 5) has always been an independent risk factor of 28-day mortality. Both NUTRIC and mNUTRIC scores were able to predict 28-day mortality, with area under the receiver operating characteristic curves of 0.857 (95% CI, 0.786-0.928) and 0.856 (95% CI, 0.786-0.927), respectively. The mNUTRIC scoring system is not only a useful tool for nutrition risk assessment but also, and more importantly, it is independently related to the risk of 28-day mortality in NICU patients. Therefore, mNUTRIC scoring is an appropriate tool for nutrition risk assessment and prognosis prediction of NICU patients.

Impact of nutritional risk on 28-day mortality and the prevalence of underfeeding in critically ill patients: A prospective cohort study.

Introduction: nutritional risk is an important prognostic factor in hospitalized patients, but frequently it is underappreciated and not considered as a part of the prognostic evaluation in patients from intensive care units. Objective: to evaluate the association between nutritional risk and 28-day mortality and characterize the nutritional support in critically ill patients. Methods: this was a single-center, prospective cohort study was performed over 7 months in a Medical-surgical ICU of a tertiary hospital in Mexico. From 352 admissions a consecutive sample of 110 patients was included. All of them were ≥ 18 years old, with ≥ 48 h of stay in ICU and with the consent to participate. Nutritional risk assessed by the modified NUTRIC score (mNUTRIC score), 28-day mortality and nutritional support characteristics were recorded. Results: the patient characteristics: mean age 50.7 ± 16.8 years, APACHE II score 15.5 ± 5.8, SOFA score 6.9 ± 3, invasive mechanical ventilation (IMV) 65.5 % and 28-day mortality 23.6 %. High nutritional risk (31.8 %) was associated with 28-day mortality (RR 5.81, 95 % CI 2.69-12.53). In the surviving group, the mNUTRIC score correlated with the length of stay (LOS) in the ICU (r = 0.216, p = 0.049), LOS in the hospital (r = 0.230, p = 0.036) and IMV duration (r = 0.306, p = 0.037). Nutritional support was administered in 55.4 % of the patients, reaching only 52.9 % and 46 % of the energy and protein requirements, respectively. Only 18 % and 21.3 % of the patients achieved the energy and protein requirements, respectively. Conclusions: high nutritional risk was associated with a higher risk of 28-day mortality. Less than a quarter of the patients receiving nutritional support reached the energy and protein requirements.

The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients.

Background & aimsIn the newly emerged Coronavirus Disease 2019 (COVID-19) disaster, little is known about the nutritional risks for critically ill patients. It is also unknown whether the modified Nutrition Risk in the Critically ill (mNUTRIC) score is applicable for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. We set out to investigate the applicability of the mNUTRIC score for assessing nutritional risks and predicting outcomes for these critically ill COVID-19 patients.MethodsThis retrospective observational study was conducted in three ICUs which had been specially established and equipped for COVID-19 in Wuhan, China. The study population was critically ill COVID-19 patients who had been admitted to these ICUs between January 28 and February 21, 2020. Exclusion criteria were as follows: 1) patients of ＜18 years; 2) patients who were pregnant; 3) length of ICU stay of ＜24 h; 4) insufficient medical information available. Patients' characteristics and clinical information were obtained from electronic medical and nursing records. The nutritional risk for each patient was assessed at their ICU admission using the mNUTRIC score. A score of ≥5 indicated high nutritional risk. Mortality was calculated according to patients’ outcomes following 28 days of hospitalization in ICU.ResultsA total of 136 critically ill COVID-19 patients with a median age of 69 years (IQR: 57–77), 86 (63%) males and 50 (37%) females, were included in the study. Based on the mNUTRIC score at ICU admission, a high nutritional risk (≥5 points) was observed in 61% of the critically ill COVID-19 patients, while a low nutritional risk (<5 points) was observed in 39%. The mortality of ICU 28-day was significantly higher in the high nutritional risk group than in the low nutritional risk group (87% vs 49%, P ＜0.001). Patients in the high nutritional risk group exhibited significantly higher incidences of acute respiratory distress syndrome, acute myocardial injury, secondary infection, shock and use of vasopressors. Additionally, use of a multivariate Cox analysis showed that patients with high nutritional risk had a higher probability of death at ICU 28-day than those with low nutritional risk (adjusted HR = 2.01, 95% CI: 1.22–3.32, P = 0.006).ConclusionsA large proportion of critically ill COVID-19 patients had a high nutritional risk, as revealed by their mNUTRIC score. Patients with high nutritional risk at ICU admission exhibited significantly higher mortality of ICU 28-day, as well as twice the probability of death at ICU 28-day than those with low nutritional risk. Therefore, the mNUTRIC score may be an appropriate tool for nutritional risk assessment and prognosis prediction for critically ill COVID-19 patients.

Comparison of Feeding Efficacy and Hospital Mortality Between Small Bowel and Nasogastric Tube Enteral Nutrition in Critical Illness at High Nutritional Risk

Abstract Objectives The current guidelines recommend that early enteral nutrition (EN) support by nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h in the critically ill patients at high nutritional risk. Small bowel EN (SBEN) was suggested for those who are NGEN intolerance. Our previous study showed adjuvant feeding with SBEN at 7th ICU day may improve feeding efficacy and have survival benefit for those energy achievement rate more than 65% at the 3rd day after SBEN. However, the comparison of feeding efficacy and hospital mortality between SBEN and NGEN remains unclear. Methods A retrospective cohort study enrolled 113 critically ill patients at high nutrition risk (modified NUTRIC score≧5) and at inadequate feeding volume (&amp;lt; 750 ml/day) in the first week of ICU stay. Patients were classified into SBEN (N = 48) and NGEN (N = 65) group at 8th ICU day (enrolled day). Daily actual energy intake was recorded after enrolled day in each group and feeding efficiency was compared between two groups. Cox regression analysis was used to assess factors associated with hospital mortality. Results The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly in the SBEN group at the 3rd following day (P &amp;lt; 0.001). Hospital mortality in this cohort was 43.3%. By univariate analysis, SBEN group (HR: 0.56, 95% CI: 0.31–1.00, P = 0.049), SOFA score at day 7 (HR:1.12, 95% CI: 1.03–1.22, P = 0.009) and energy intake achievement rate &amp;lt; 65% at the 3rd followed-up day (HR: 2.53, 95% CI: 1.25–5.11, P = 0.010) were associated with hospital mortality. By multivariate analysis, the only factor associated hospital mortality in this cohort was energy intake achievement rate &amp;lt; 65% at the 3rd followed-up day (HR: 2.29, 95% CI: 1.12–4.69, P = 0.023). Conclusions SBEN improves energy delivery and might be reduced in hospital mortality in critically ill patients at high nutritional risk after 1 week of stomach enteral nutrition in ICU. Funding Sources None.

Validation of the modified NUTRIC score on critically ill Jordanian patients: A retrospective study.

Nutritional status has been proven to be associated with poor outcomes in mechanically ventilated patients in intensive care units (ICU). Nutritional assessment has been assessed using different tools. Few data are available on the validity of the modified Nutrition Risk Assessment Tool for Critically Ill (mNUTRIC) score in ICU patients receiving mechanical ventilation (MV). This study aimed to assess prognostic performance of the mNUTRIC score for discriminative abilities for 30-day mortality and prolonged MV. This was a multi-centre retrospective study that included 737 mechanically ventilated patients using secondary data analysis. Data were collected on variables required to calculate mNUTRIC score. Patients with a mNUTRIC score ≥5 were considered at nutritional risk. Predictive performance of the mNUTRIC was assessed for discriminative abilities for Acute Physiology and Chronic Health Evaluation II at baseline, mortality in 42 days of follow-up and outcomes related to MV. A total of 737 patients on MV met the inclusion criteria. The majority (57.1%) of patients were male. The mean age of the participants was 62.1±18 years. Of all patients, 482 (58%) were at high nutritional risk (mNUTRIC score ≥5). Median ventilator days were 3 (±7.2) days and 72 (±174) hours. The overall mortality rate was 78.8% (n=652), and weaning failure was 79.8% (n=660). This study showed new evidence on the validity of the mNUTRIC as a tool for assessing nutritional risk in an ICU population in Jordan. The mNUTRIC score obtained from the current retrospective data suggests that the use of the tool can truly identify and diagnose critically ill patients with malnutrition.

Derivation and validation of a new nutritional index for predicting 90 days mortality after ICU admission in a Korean population

Predicting the mortality in patients admitted to the ICU is important for determining a treatment strategy and public health policy. Although many scores have been developed to predict the mortality, these scores were based on Caucasian population. We aimed to develop a new prognostic index, the New nutritional index (NNI), to predict 90-days mortality after ICU admission based on Korean population. Patients (1453) who admitted intensive care unit (ICU) of the Gangnam Severance hospital were analyzed. After exclusion, 984 patients were randomly divided into internal (n=702) and external validation (n=282) data set. The new nutritional index (NNI) was developed using univariate and multivariate logistic regression with backward selection of predictors. Receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC) verified the better predictor of 90 days-mortality after ICU admission. The NNI better predicted 90 days-mortality compared to modified NUTRIC score, APACHE II scores, SOFA scores, CRP, glucose, total protein, and albumin level in internal and external data sets, with AUC of 0.862 (SE: 0.017, 95% CI: 0.829-0.895) and 0.858 (SE: 0.015, 95% CI: 0.829-0.887), respectively. The calibration plots using external data set for validation showed a close approximation to the logistic calibration of each nomogram, and p-value of Hosmer and Lemeshow test was 0.1804. The NNI has advantages as a predictor of 90 days mortality based on nutritional status in the Korean population.

Association between nutrition support and acute gastrointestinal injury in critically ill patients during the first 72 hours.

The impact of nutrition support on patients with acute gastrointestinal injury (AGI) has not been fully determined. This study aimed to 1) investigate the relationship between nutrition support and AGI, as well as nutrition support and prognosis in critically ill AGI patients and 2) evaluate the prognostic benefits of nutrition support in different severity categories of AGI patients. This prospective study included 379 patients in whom AGI occurred in the first 72h after admission from 12 teaching hospitals in China. Clinical characteristics including demographics, APACHE II score, modified NUTRIC score, SOFA score, calories of nutrition, and 7 and 28-day mortality were recorded. Multiple logistic regression analysis was applied to identify the risk factors for mortality. The survival benefit of nutrition support as reflected by calories of nutrition in 72h was evaluated for patients categorized according to their APACHE II, modified NUTRIC, and SOFA scores. Patients were classified into Grades I (n=141), II (n=173), III (n=48), and IV (n=17). Significant differences were observed among different AGI grade cohorts (I-IV) in terms of APACHE II, SOFA, and modified NUTRIC scores and calories of enteral nutrition (EN), parenteral nutrition (PN), and EN+PN. Ordinal logistic regression analysis showed that only SOFA score was an independent risk factor for AGI grades (P<0.001). APACHE II score, mechanical ventilation (MV), AGI grades, and calories of EN+PN intake were independent risk factors for 28-d mortality. Increased nutritional intake was associated with reduced mortality in severely ill patients with APACHE II scores ≥15 (P=0.007). AGI grade affected the intake of calories and was one of the risk factors for 28-d mortality. The nutrition intake of patients with AGI grade III to IV was almost only PN. The positive association between nutrition support and prognosis was more apparent in AGI patients with higher APACHE II scores.

88 Validation of the Modified NUTrition Risk Score (mNUTRIC) in Burn Victims: Evidence from a Multi-centre, Multi-national, Double-blind, Controlled Randomized Clinical Trial

Abstract Introduction Nutrition is an essential therapy in burn victims. However, whether nutrition therapy provide benefits equally to all burn victims is unknown. The NUTRIC score identifies patients who may not benefit more from aggressive nutrition therapy (score &amp;lt; 5) and those who may benefit more from aggressive nutrition (High score ≥ 5). It can be estimated from age, SOFA, APACHE scores, comorbidities, and IL-6. If the latter is not available, the modified NUTRIC score (mNUTRIC) can be computed. The mNUTRIC score has been validated in ICU settings. In burn victims, the association between mNUTRIC score, nutritional intake, and clinical outcomes is unknown. We hypothesize that a higher mNUTRIC score will be associated with worst clinical outcomes and that greater nutritional adequacy will be associated with better clinical outcomes in nutritionally high-risk burn victims. Methods In the context of a double-blind, placebo-active, multi-centre RCT of adult burn patients, we evaluated the association between mNUTRIC score, nutritional adequacy, and clinical outcomes. Patients with deep second and/or third-degree burns with a total body surface area percentage (TBSA%) ≥10 were enrolled in the RCT. Patients demographics, type of burn, %TBSA, nutrition intake, hospital length of stay (LOS), Burn Unit (BU) LOS, and hospital mortality were collected. The nutritional adequacy was calculated from all sources, except intravenous glucose and oral intake. Descriptive and inferential analyses for quantitative data were performed. Results Six hundred and sixty patients were included. The majority were Caucasian (78%) males (74%) with a BMI between 25–35 (53%), median age of 50 ±18 years and severely ill (Apache Score II; 14 ±8, SOFA score; 2.9 ±3). The most common type of burn was fire (87%), with %TBSA of 31 ±16, Table 1. EN alone was provided to 79% of the patients and the daily average energy and protein adequacy was 73% and 76%, accordingly. Table 2. Compared to low mNUTRIC, the high mNUTRIC group had less ventilator free days (11 [6–19] vs. 28 [11–28] days), worse survival (52% vs. 9.5%), and longer hospital LOS (181 [81–181] vs. 34 [20–68] days), Table 3. Compared to the low mNUTRIC, the high mNUTRIC group had better clinical outcomes with increasing energy (by 20% of goal), interaction for energy, mNUTRIC, and mortality was p=0.11 and for time-discharge-alive was &amp;lt; p=0.0001. Similarly, more protein tended towards better outcomes in the high mNUTRIC group but not the low NUTRIC group (interaction for protein, mNUTRIC, mortality was p=0.20; time-to-discharge alive was p=0.08, Table 4. Conclusions A high mNUTRIC score identifies high risk burn victims and may identify those who may benefit more from an aggressive nutrition therapy. Applicability of Research to Practice Nutrition therapy in burns can be more efficient.

Yoğun bakım hastalarında diyabetes mellitus malnütrisyonla ilişkili midir? Diyabet ve malnütrisyon

Aim: Types of diseases and treatment modalities can also lead to the exacerbation of malnutrition. The aim of this study was to investigate nutritional status of patients with diabetes mellitus in the intensive care unit of a tertiary hospital.Materials and methods: One hundred and ninety-two patients were enrolled and divided into two groups. The study group comprised of 77 patients with type 2 diabetes and the control group comprised of 115 patients without diabetes. The nutritional risk assessment was tested with NRS (Nutritional Risk Screening) 2002, Nutric score, MNA (Mini-Nutritional Assessment) and MUST (Malnutrition Universal Screening Tool). Results: The groups were comparable according to the NRS 2002 (3.37 ± 1.84 vs. 3.93 ± 1.72, p = 0.075), Nutric score (4.61 ± 1.85 vs. 4.56 ± 1.85, p = 0.869), MNA (8.0 ± 3.1 vs. 7.1 ± 3.2, p = 0.068) and MUST score (1.62 ± 1.46 vs. 1.81 ± 1.59, p = 0.456). Conclusion: In this study, the risk of malnutrition is comparable in both groups. This result may suggest that malnutrition is also related to co-morbidities in addition to diabetes.

NUTRIC Score: Isolated and Combined Use With the NRS-2002 to Predict Hospital Mortality in Critically Ill Patients.

Identification of nutritional risk in critically ill patients is a challenge because each nutritional screening tool has its specific characteristics. The objective was to evaluate the performance of the modified Nutrition Risk in Critically ill (mNUTRIC) score, used alone or in combination with the Nutritional Risk Screening 2002 (NRS-2002) score, to predict hospital mortality in critically ill patients. A prospective study was performed with patients admitted to the intensive care unit (ICU) from October 2017 to April 2018. Multiple logistic regression analysis was used to test for complementarity between the mNUTRIC and NRS-2002. A receiver operating characteristic (ROC) curve was used to identify the performance of the instruments to predict mortality. This study was conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. 384 patients were evaluated (51.8% female mean age 59.6 ± 16.7 years). High nutritional risk was detected in 54.4% by the NRS-2002 and 48.4% by mNUTRIC. The overall mortality rate was 36.5% (n = 140). Patients in whom nutritional risk was identified both by mNUTRIC and by NRS-2002 (score ≥5) had a twofold greater risk of in-hospital mortality (RR = 2.29; 95%CI: 1.42-3.68; p = 0.001). The area under the ROC curve to predict mortality was 0.693 for mNUTRIC; 0.645 for NRS-2002; and 0.666 for mNUTRIC and NRS-2002 combined. The mNUTRIC and NRS-2002 scores had similar performance in predicting hospital mortality. The mNUTRIC has better discriminant ability to quantify the risk of mortality in critically ill patients.

Estado nutricional e desfechos clínicos em pacientes críticos internados em hospital universitário

Introduction: There is a strong relationship between malnutrition and increased length of hospitalization and morbidity and mortality. Studies have shown that malnourished patients can have up to twenty times more complications than eutrophic ones. In critically ill patients, there is a tendency to catabolism, resulting in the loss of lean body mass, which when it reaches 40% is usually lethal. Methods: A quantitative, descriptive study was conducted on adults from both genders, admitted to the intensive care unit (ICU) of a university hospital, from March to December 2018. The following variables were collected from the evaluation and nutritional records: length of hospitalization in the ICU, date of discharge or death, nutritional risk through specific screening, height, weight and arm circumference (AC). For the screening, the Nutric score was used. For the nutritional evaluation, the body mass index (BMI) and AC indicators and the classifications recommended by the World Health Organization (2004) and Blackburn and Thornton (1979) were used. After collecting the data, they were analyzed in the Statistical Package for Social Sciences (SPSS) 13.0 and for the association of the variables the Chi-square test was used, considering statistical difference when the p value &lt;0.05. Results: The sample consisted of 116 patients, mostly female (53.4%) whose median age was 46 years (interquartile range IQR 31-53). Regarding the frequency of nutritional risk, most patients (61.5%) had a low score. There was an important frequency of malnutrition, according to the AC indicator (73%), although BMI (43.5%) showed eutrophy. Even though most patients had low nutritional risk, those with high nutritional risk (38.5%) had a higher tendency to mortality, however, not statistically confirmed (p&gt; 0.05). There was also a tendency of association between death and malnutrition, although no statistical significance was shown(p&gt; 0.05). Conclusion: Patients at nutritional risk and/or malnutrition appear to be vulnerable to worse clinical outcomes.

Comparison of Different Early Enteral Feeding Formulas on Critically Ill Patients.

Critically ill patients are physiologically unstable, often have complex hypermetabolic responses to trauma. These patients are facing a high risk of death, multi-organ failure, and prolonged ventilator use. Nutrition is one of therapy for critical illness, however, patients often experience malnutrition caused by disease severity, delays in feeding, and miscalculation of calorie needs. The study aims to evaluate clinical improvement in critically ill participants that were given 3 kinds of early enteral feeding formulas, which were control (5% Dextrose), high-protein polymeric, or oligomeric formulas. A total of 55 critically ill participants admitted to the intensive care unit (ICU) between October 2017-March 2018 and assigned in this controlled trial. Early enteral feeding was initiated within 24-48 h after ICU admission. Each enteral feeding group were categorized to traumatic brain injury (TBI) or non-TBI. The primary endpoints were changes in white blood cell count, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and Nutrition Risk in the Critically Ill (NUTRIC) score from baseline to day 3. Baseline characteristics were similar between control (n=22), high-protein polymeric (n=19) and oligomeric (n=14) groups. There were significant decreases for white blood cell count (13,262.5±6,963.51 to 11,687.5±7,420.92; p=0.041), APACHE II score (17.33±3.31 to 13.83±1.95; p=0.007), and NUTRIC scores changes (3.08±1.44 to 1.92±1.00; p=0.022) in non-TBI participants receiving highprotein polymeric compared those in control or oligomeric participants. But there is no significant clinical improvement in TBI patients. In conclusion, non-TBI patients benefit from early enteral feeding with high-protein polymeric formula.

Modified NUTRIC score and outcomes in critically ill patients: A meta-analysis

ABSTRACT Early identification of malnourished, critically ill patients helps initiate prompt treatment and improve patients’ outcomes. Most nutrition screening tools were not suitable for critically ill patients. This study was conducted to evaluate the modified nutrition risk in critically ill (mNUTRIC) score as a screening tool for nutrition risk in critically ill patients. Search was conducted in Medline, PubMed, and the Egyptian Knowledge Bank for cohort studies that were published in English until 1 March 2019. Eight studies with a total number of 4076 patients were included in this meta-analysis. Estimates and their 95% confidence intervals (CI) were calculated, then pooled for analysis. High mNUTRIC score (5 or above) in critically ill patients was related to increased risk of 28-day mortality (relative risk = 2.025; 95% CI = 1.488–2.758; p < 0.001; risk difference = 0.159; 95% CI = 0.120–0.198; p < 0.001), increased ICU length of stay (95% CI = 1.78–4.99 days; p < 0.001), and longer duration of mechanical ventilation (95% CI = 3.01–4.73 days; p < 0.001). Association of High mNUTRIC score with these parameters indicates that it might be used as a tool to predict poorer clinical outcomes in those patients.

Comparison of Nutric Score, Nutritional Risk Screening (NRS) 2002 and Subjective Global Assessment (SGA) in the ICU: a Cohort Study

Comparison of Nutric Score, Nutritional Risk Screening (NRS) 2002 and Subjective Global Assessment (SGA) in the ICU: a Cohort Study

A multicenter cross-sectional study on chronic critical illness and surgery-related chronic critical illness in China

Objective: To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China. Methods: The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis. Results: Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ(2)=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ(2)=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ(2)=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg(-1)·d(-1), 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient's condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg(-1)·d(-1), and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg(-1)·d(-1), and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150). Conclusion: The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.

Use of the modified “Nutrition Risk in the critically ill” score and its association with the death of critically ill patients

To evaluate the application of the modified NUTRIC score in screening for nutritional risk in intensive care patients and its association with death. Observational, longitudinal, prospective study conducted between February 2017 and January 2018 with 83 patients of both sexes and over 20 years of age from the ICUs of a private hospital. All inpatients were eligible, except: patients with exogenous intoxication, with a length of stay of less than 24h, and surgical patients. The mNUTRIC score was applied in the first 24h of admission. Those with an mNUTRIC score of ≥5 were classified as being at risk. Of the total number of participants, 51.8% (n=43) were male and 48.2% (n=40) were female, with a mean age of 72.5 years (20-108). The mean ICU length of stay was five (3-8) days, mechanical ventilation was required by 19.3% of the patients, and their mean total hospitalization time was 12.56 (1-30) days. There was a significant association of a high mNUTRIC score with older patients (p=0.002), a lower pH (p=0.029), higher lactate concentration (p=0.004), and higher number of comorbidities (p=0.024). A total of 12% (n=10) of the patients died and there was a significant association between a high mNUTRIC score and death (χ2 5.918; p=0.024). Patients with a high mNUTRIC score were older, had a higher number of comorbidities and severity criteria, and had a significantly higher death rate, indicating the importance of the application of a specialized tool and consequent follow-up nutrition.

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.

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.

Association of High Serum Adiponectin with the Risk of Malnutrition and Worse Outcome in Head Trauma Patients; a Cohort study.

A number of studies have shown the association between serum adiponectin level and the nutritional status. This study aimed to evaluate the relation between serum adiponectin and changes in nutritional status of head trauma patients. The current prospective cohort study was carried out on head trauma patients who were hospitalized in ICU of a General Teaching Hospital, Sulaimani, Iraq. Patients were divided into two groups based on their serum adiponectin level during the first 24 hours of admission (<15mg/L and ≥15 mg/L) and malnutrition and nutritional indices were compared between groups 1, 6 and 13 days after admission. Sixty-four patients with the mean age of 35.97 ± 11.5 years were studied (59.4% male; 57% traffic accidents). The nutritional status of head trauma patients with serum adiponectin ≥15 mg/L significantly deteriorated from day 1 to 13 based on different nutritional status indices. BMI (p = 0.08), LBM (p = 0.002), APM (p = 0.009), and MUAC (p = 0.008) had a significant decreasing trend from day 1 to day 13 in patients with serum adiponectin level ≥ 15 mg/L. In addition, the number of high risk patients for developing malnutrition based on NUTRIC score (p < 0.001) and the number of severely malnourished cases based on SGA score (p < 0.001) significantly increased from day 1 to 13 in this group. The severity of disease based on APACHE (p < 0.001) and SOFA (p < 0.001) scores increased in the mentioned cases during the follow up period. Serum adiponectin level ≥ 15 is associated with significant deterioration in nutritional status, increase in the risk of malnutrition, and worsening of the clinical outcome in patients with moderate to severe head trauma in ICU.

The use of nutritional screening tools in the intensive therapy unit

Patients requiring advanced organ support are often malnourished. A rapid, simple and reasonably accurate method of identifying malnutrition is through the use of a screening tool. Indeed, a nutritional screen is required to complete a full holistic clinical assessment. Organizations such as ESPEN (the European Society for Parenteral and Enteral Nutrition) recommend standardization of nutritional screening (i.e. use of a single tool across a region). Many tools for nutritional screening have been developed. None have been fully validated for use in the intensive therapy unit (ITU). Moreover, most of these tools consider all critically ill patients to be malnourished or at high risk of malnutrition. However, not all patients in the ITU will benefit from nutritional interventions. For this reason, the Nutrition Risk in Critically ill (NUTRIC) score was developed specifically for patients in ITU. However a recent analysis of the PermiT trial failed to demonstrate any benefit on outcomes associated with the use of the NUTRIC Score. Recommendations on use of a tool for nutritional screening can, therefore, only be based on expert opinion. Those ITUs awaiting a validated tool should adopt a pragmatic approach to identify patients at risk of malnutrition. For those ITUs that are using a tool for screening it is best if this is used at first contact with the patient by a healthcare professional (e.g. a nurse or a doctor) who is not a specialist in nutrition. Subsequently, recurrent, sequential screening can plot the trajectory of a patient’s nutritional status along the timeline of their admission to hospital. This can be continued after step down from ITU to the ward and discharge home. This simple sequential assessment can inform past, present and/or future risk of malnutrition. The subsequent prevention and treatment of malnutrition depend on the management after screening. Thus a support structure for nutritional interventions (e.g. measurement tools, documentation, follow-up plans) is as important as the tools themselves. Citation: Rajendram R, Khan MF. The use of nutritional screening tools in the intensive therapy unit. Anaesth. pain &amp; intensive care 2019;23(2):231-236

Relationship between Nutrition Intake and 28-Day Mortality Using Modified NUTRIC Score in Patients with Sepsis.

In critically ill patients, malnutrition is known to increase morbidity and mortality. We investigated the relationship between nutritional support and 28-day mortality using the modified NUTrition RIsk in the Critically ill (NUTRIC) score in patients with sepsis. This retrospective cohort study included patients with sepsis admitted to the medical intensive care unit (ICU) between January 2011 and June 2017. Nutritional support for energy and protein intakes at day 7 of ICU admission were categorized into <20, 20 to <25, and ≥25 kcal/kg and <1.0, 1.0 to <1.2, and ≥1.2 g/kg, respectively. NUTRIC scores ≥4 were considered to indicate high nutritional risk. Among patients with low nutritional risk, higher intakes of energy (≥25 kcal/kg) and protein (≥1.2 g/kg) were not significantly associated with lower 28-day mortality. In patients with high nutritional risk, higher energy intakes of ≥25 kcal/kg were significantly associated with lower 28-day mortality compared to intakes of <20 kcal/kg (adjusted hazard ratio (aHR): 0.569, 95% confidence interval (CI): 0.339–0.962, p = 0.035). Higher protein intakes of ≥1.2 g/kg were also significantly associated with lower 28-day mortality compared to intakes of <1.0 g/kg (aHR: 0.502, 95% CI: 0.280–0.900, p = 0.021). Appropriate energy (≥25 kcal/kg) and protein (≥1.2 g/kg) intakes during the first week may improve outcomes in patients with sepsis having high nutritional risk.