Complementarity of Modified NUTRIC Score with or Without C-reactive Protein and Subjective Global Assessment in Predicting Mortality in Critically Ill Patients

Overview

Journal Rev Bras Ter Intensiva

Specialties Critical Care
General Medicine

Date 2020 Jan 23

PMID 31967223

Citations 8

Authors

Manoela Lima Oliveira

Daren Keith Heyland

Flavia Moraes Silva

Estela Iraci Rabito

Mariane Rosa

Micheli da Silva Tarnowski

Daieni Fernandes

Aline Marcadenti

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the concordance between the modified NUTRIC and NUTRIC with C-reactive protein instruments in identifying nutritional risk patients and predicting mortality in critically ill patients. The risk of death in patient groups was also investigated according to nutritional risk and malnutrition detected by subjective global assessment.

Methods: A cohort study of patients admitted to an intensive care unit. Nutritional risk was assessed by modified NUTRIC and a version of NUTRIC with C-reactive protein. Subjective global assessment was applied to diagnose malnutrition. Kappa statistics were calculated, and an ROC curve was constructed considering modified NUTRIC as a reference. The predictive validity was assessed considering mortality in 28 days (whether in the intensive care unit or after discharge) as the outcome.

Results: A total of 130 patients were studied (63.05 ± 16.46 years, 53.8% males). According to NUTRIC with C-reactive protein, 34.4% were classified as having a high score, while 28.5% of patients had this classification with modified NUTRIC. According to SGA 48.1% of patients were malnourished. There was excellent agreement between modified NUTRIC and NUTRIC with C-reactive protein (Kappa = 0.88, p < 0.001). The area under the ROC curve was equal to 0.942 (0.881 - 1.000) for NUTRIC with C-reactive protein. The risk of death within 28 days was increased in patients with high modified NUTRIC (HR = 1.827; 95%CI 1.029 - 3.244; p = 0.040) and NUTRIC with C-reactive protein (HR = 2.685; 95%CI 1.423 - 5.064; p = 0.002) scores. A high risk of death was observed in patients with high nutritional risk and malnutrition, independent of the version of the NUTRIC score applied.

Conclusion: An excellent agreement between modified NUTRIC and NUTRIC with C-reactive protein was observed. In addition, combining NUTRIC and subjective global assessment may increase the accuracy of predicting mortality in critically ill patients.

Citing Articles

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China.

Guan X, Chen D, Xu Y J Intensive Med. 2024; 4(2):137-159.

PMID: 38681796 PMC: 11043647. DOI: 10.1016/j.jointm.2023.12.002.

Prognostic values of modified NUTRIC score to assess outcomes in critically ill patients admitted to the intensive care units: prospective observational study.

Mahmoodpoor A, Sanaie S, Sarfaraz T, Shadvar K, Fattahi V, Hamishekar H BMC Anesthesiol. 2023; 23(1):131.

PMID: 37081414 PMC: 10116464. DOI: 10.1186/s12871-023-02086-0.

Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality.

Kim S, Lee H, Choi S, Lee S, Lee J Acute Crit Care. 2022; 37(4):618-626.

PMID: 36330740 PMC: 9732204. DOI: 10.4266/acc.2022.00612.

Significance of the Modified NUTRIC Score for Predicting Clinical Outcomes in Patients with Severe Community-Acquired Pneumonia.

Tseng C, Tu C, Chen C, Wang Y, Chen W, Fu P Nutrients. 2022; 14(1).

PMID: 35011073 PMC: 8747298. DOI: 10.3390/nu14010198.

High neutrophil-to-lymphocyte ratio at intensive care unit admission is associated with nutrition risk in patients with COVID-19.

Martins P, Gomes T, Franco E, Vieira L, Pimentel G JPEN J Parenter Enteral Nutr. 2021; 46(6):1441-1448.

PMID: 34961953 PMC: 9015430. DOI: 10.1002/jpen.2318.

References

Singer P, Reintam Blaser A, Berger M, Alhazzani W, Calder P, Casaer M . ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2018; 38(1):48-79. DOI: 10.1016/j.clnu.2018.08.037. View

Rahman A, Hasan R, Agarwala R, Martin C, Day A, Heyland D . Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the "modified NUTRIC" nutritional risk assessment tool. Clin Nutr. 2015; 35(1):158-162. DOI: 10.1016/j.clnu.2015.01.015. View

Moretti D, Bagilet D, Buncuga M, Settecase C, Quaglino M, Quintana R . [Study of two variants of nutritional risk score “NUTRIC” in ventilated critical patients]. Nutr Hosp. 2014; 29(1):166-72. DOI: 10.3305/nh.2014.29.1.7001. View

Cui N, Zhang H, Chen Z, Yu Z . Prognostic significance of PCT and CRP evaluation for adult ICU patients with sepsis and septic shock: retrospective analysis of 59 cases. J Int Med Res. 2019; 47(4):1573-1579. PMC: 6460616. DOI: 10.1177/0300060518822404. View

Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D . Use of 3 tools to assess nutrition risk in the intensive care unit. JPEN J Parenter Enteral Nutr. 2014; 39(1):28-33. DOI: 10.1177/0148607114532135. View

Jensen G, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba R . Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Clin Nutr. 2010; 29(2):151-3. DOI: 10.1016/j.clnu.2009.11.010. View

McClave S, Taylor B, Martindale R, Warren M, Johnson D, Braunschweig C . Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016; 40(2):159-211. DOI: 10.1177/0148607115621863. View

Atalay B, Yagmur C, Nursal T, Atalay H, Noyan T . Use of subjective global assessment and clinical outcomes in critically ill geriatric patients receiving nutrition support. JPEN J Parenter Enteral Nutr. 2008; 32(4):454-9. DOI: 10.1177/0148607108314369. View

Fontes D, de Vasconcelos Generoso S, Correia M . Subjective global assessment: a reliable nutritional assessment tool to predict outcomes in critically ill patients. Clin Nutr. 2013; 33(2):291-5. DOI: 10.1016/j.clnu.2013.05.004. View

10.

Mukhopadhyay A, Henry J, Ong V, Leong C, Teh A, van Dam R . Association of modified NUTRIC score with 28-day mortality in critically ill patients. Clin Nutr. 2016; 36(4):1143-1148. DOI: 10.1016/j.clnu.2016.08.004. View

11.

. Disease-related malnutrition and enteral nutrition therapy: a significant problem with a cost-effective solution. Nutr Clin Pract. 2010; 25(5):548-54. DOI: 10.1177/0884533610378524. View

12.

de Vries M, Kristine Koekkoek W, Opdam M, van Blokland D, van Zanten A . Nutritional assessment of critically ill patients: validation of the modified NUTRIC score. Eur J Clin Nutr. 2017; 72(3):428-435. PMC: 5842932. DOI: 10.1038/s41430-017-0008-7. View

13.

Jensen G . Inflammation as the key interface of the medical and nutrition universes: a provocative examination of the future of clinical nutrition and medicine. JPEN J Parenter Enteral Nutr. 2006; 30(5):453-63. DOI: 10.1177/0148607106030005453. View

14.

Ozbilgin S, Hanci V, Omur D, Ozbilgin M, Tosun M, Yurtlu S . Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine (Baltimore). 2016; 95(40):e5038. PMC: 5059069. DOI: 10.1097/MD.0000000000005038. View

15.

Lew C, Cheung K, Chong M, Chua A, Fraser R, Miller M . Combining 2 Commonly Adopted Nutrition Instruments in the Critical Care Setting Is Superior to Administering Either One Alone. JPEN J Parenter Enteral Nutr. 2017; :148607117726060. DOI: 10.1177/0148607117726060. View

16.

Ugarte H, Silva E, Mercan D, de Mendonca A, Vincent J . Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med. 1999; 27(3):498-504. DOI: 10.1097/00003246-199903000-00024. View

17.

Bharadwaj S, Ginoya S, Tandon P, Gohel T, Guirguis J, Vallabh H . Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep (Oxf). 2016; 4(4):272-280. PMC: 5193064. DOI: 10.1093/gastro/gow013. View

18.

Rosa M, Heyland D, Fernandes D, Rabito E, Oliveira M, Marcadenti A . Translation and adaptation of the NUTRIC Score to identify critically ill patients who benefit the most from nutrition therapy. Clin Nutr ESPEN. 2017; 14:31-36. DOI: 10.1016/j.clnesp.2016.04.030. View

19.

Jensen G, Bistrian B, Roubenoff R, Heimburger D . Malnutrition syndromes: a conundrum vs continuum. JPEN J Parenter Enteral Nutr. 2009; 33(6):710-6. DOI: 10.1177/0148607109344724. View

20.

Jeong D, Hong S, Lim C, Koh Y, Seo J, Kim Y . Comparison of Accuracy of NUTRIC and Modified NUTRIC Scores in Predicting 28-Day Mortality in Patients with Sepsis: A Single Center Retrospective Study. Nutrients. 2018; 10(7). PMC: 6073879. DOI: 10.3390/nu10070911. View