The prognostic value of modified NUTRIC score for patients in cardiothoracic surgery recovery unit: A retrospective cohort study

Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis

Purpose

The purpose of our meta-analysis was to look at the impact of modified nutrition risk in the critically ill (mNUTRIC) on mortality in patients with critical illness.

Materials and methods

Literature relevant to this meta-analysis was searched in PubMed, Web of Science, and Cochrane Library till 26 August 2023. Prospective or retrospective studies, patients >18 years of age, studies that reported on mortality and mNUTRIC (mNUTRIC cut-off score) were included. The QUIPS tool was used to evaluate the risk for bias in prognostic factors.

Results

A total of 31 studies on mNUTRIC score, involving 13,271 patients were included. The summary area under the curve (sAUC) of 0.80 (95% CI: 0.76-0.83) illustrates the mNUTRIC score's strong discrimination. The pooled sensitivity was 0.79 (95% CI: 0.74-0.84) and pooled specificity was 0.68 (95% CI: 0.63-0.73). We found no discernible variation in the mNUTRIC's prediction accuracy among cut-off values of <5 and >5 in our subgroup analysis and sAUC values were 0.82 (95% CI: 0.78-0.85) and 0.78 (95% CI: 0.74-0.81), respectively.

Conclusion

We observed that mNUTRIC can discriminate between critically ill individuals and predict their mortality.

Prospero

CRD42023460292.

How to cite this article

Prakash J, Verma S, Shrivastava P, Saran K, Kumari A, Raj K, et al. Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(5):495-503.

Ability of the modified NUTRIC score to predict mortality in patients requiring short-term versus prolonged acute mechanical ventilation: a retrospective cohort study

BACKGROUND

The modified NUTRIC (nutritional risk in the critically ill) score has been reported to predict clinical outcomes in critically ill patients. However, the applicability of this score may differ between patients undergoing short-term mechanical ventilation (STMV, < 96 h) and those undergoing prolonged acute mechanical ventilation (PAMV, ⩾96 h), as PAMV patients typically experience significantly higher morbidity and mortality.

OBJECTIVE

This study aimed to investigate the predictive ability of modified NUTRIC score for predicting 28-day mortality in patients receiving STMV and PAMV.

DESIGN

Retrospective single-center cohort study.

METHODS

We enrolled patients who received mechanical ventilation (MV) on the day of admission to the intensive care unit (ICU) from 1 December 2015 to 30 November 2020. Modified NUTRIC scores were calculated based on the clinical data of each patient at ICU admission.

RESULTS

The study population comprised 464 patients, including 319 (68.8%) men with a mean age of 69.7 years. Among these patients, 132 (28.4%) received STMV and 332 (71.6%) received PAMV. The overall 28-day mortality rate was 26.7%, which was significantly higher in STMV patients than in PAMV patients (37.9% versus 22.3%, p < 0.001). Evaluation of the predictive performance of the modified NUTRIC score for 28-day mortality revealed areas under the receiver operating characteristic curves of 0.672 [95% confidence interval (CI): 0.627-0.714] for total patients, 0.819 (95% CI, 0.742-0.880) for STMV patients, and 0.595 (95% CI, 0.540-0.648) for PAMV patients. The best overall cutoff value was 5 in total, STMV, and PAMV patients. This cutoff value was a significant predictor of 28-day mortality based on the Cox proportional hazard model for total [hazards ratio (HR): 2.681; 95% CI: 1.683-4.269] and STMV (HR: 5.725; 95% CI: 2.057-15.931) patients, but not for PAMV patients.

CONCLUSION

The modified NUTRIC score is more effective in predicting 28-day mortality in patients undergoing STMV than in those undergoing PAMV.

Reducing In-Hospital and 60-Day Mortality in Critically Ill Patients after Surgery with Strict Nutritional Supplementation: A Prospective, Single-Labeled, Randomized Controlled Trial

Malnutrition in critically ill patients is a global concern, especially those who undergo abdominal surgery, as it is associated to higher infectious complications, prolonged hospital stays, and increased morbidity. Despite the importance of proper nutrition, guidelines remain broad, and practical implementation is often inadequate. We aimed to assess the effects of strict nutritional provision and investigate the appropriate target for nutrition support. A prospective, randomized controlled trial was conducted in critically ill patients admitted to intensive care units following abdominal surgery. The intervention group received targeted protein and calories, with consultation from a nutritional support team upon admission. In total, 181 patients in the intervention and 144 in the control group were analyzed. The intervention group demonstrated improved nutrition provision and subsequently better clinical outcomes, including a reduced 60-day mortality (4.4 versus 15.3, p = 0.001), postoperative complications (24.9 versus 47.2, p < 0.001), and in-hospital mortality (5 versus 17.4, p < 0.001). High modified nutrition risk in the critically ill scores [odds ratio (OR) = 2.658, 95% CI = 1.498-4.716] were associated with increased 60-day mortality, while active nutritional intervention (OR = 0.312, 95% CI = 0.111-0.873) was associated with lower mortality rates. Notably, the provision of targeted energy and protein alone did not exhibit a significant association with mortality outcomes.

The Prognostic Value of Johns Hopkins Hospital Nutrition Support Score in Older Patients Undergoing Cardiovascular Surgery

OBJECTIVES

Clarify the prognostic value of the Johns Hopkins Hospital Nutrition Support (JHHNS) score on clinical outcomes in older patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB).

DESIGN

A retrospective observational study.

SETTING

A teaching and university hospital and tertiary referral center.

PARTICIPANTS

The authors analyzed 328 older patients aged ≥65 who underwent cardiovascular surgery with CPB in 2020.

INTERVENTIONS

Malnutrition risk was identified by the JHHNS score calculated based on specific preoperative and intraoperative objective parameters. Patients were divided into low- and high-JHHNS groups. Early morbidity, including pneumonia, bacteremia, wound infection, cerebrovascular accident, gastrointestinal bleeding, acute kidney injury, delirium, requirement for extracorporeal membrane oxygenation, and readmission to the intensive care unit (ICU), were the primary outcome; whereas in-hospital mortality, length of ICU and hospital stay, duration of mechanical ventilation and short-term mortality were secondary outcomes. The independent risk factors for postoperative complications were analyzed by logistic regression analyses.

MEASUREMENTS AND MAIN RESULTS

The JHHNS score identified 21.0% of patients at risk for malnutrition. Patients in the high-JHHNS group had prolonged median length hospital stay (21 v 24 days, p = 0.002) and mechanical ventilation (13.0 v 16.0 hours, p = 0.038), and more patients in this subgroup stayed longer than 3 days in ICU (30.1% v 43.5%, p = 0.036). Besides, they experienced more postoperative complications (11.2% v 39.1%, p < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that the JHHNS score independently predicted the risk of postoperative complications. No significant intergroup difference was observed for the short-term mortality.

CONCLUSIONS

The JHHNS score was an independent predictor for postoperative complications but did not significantly affect short-term mortality in older patients undergoing cardiovascular surgery with CPB.

The NUTRIC Score as a Tool to Predict Mortality and Increased Resource Utilization in Intensive Care Patients with Sepsis

The Nutrition Risk in Critically Ill score (NUTRIC) is an important nutritional risk assessment instrument for patients in the intensive care unit (ICU). The purpose of this study was to evaluate the power of the score to predict mortality in patients treated for sepsis and to forecast increased resource utilization and nursing workload in the ICU. The NUTRIC score predicted mortality (AUC 0.833, p < 0.001) with the optimal cut-off value of 6 points. Among patients with a score ≥ 6 on ICU admission, the 28-day mortality was 61%, and 10% with a score < 6 (p < 0.001). In addition, a NUTRIC score of ≥6 was associated with a more intense use of ICU resources, as evidenced by a higher proportion of patients requiring vasopressor infusion (98 vs. 82%), mechanical ventilation (99 vs. 87%), renal replacement therapy (54 vs. 26%), steroids (68 vs. 31%), and blood products (60 vs. 43%); the nursing workload was also significantly higher in this group. In conclusion, the NUTRIC score obtained at admission to the ICU provided a good discriminative value for mortality and makes it possible to identify patients who will ultimately require intense use of ICU resources and an associated increase in the nursing workload during treatment.

Enteral nutrition improves the prognosis and immune nutritional status of patients in the cardiothoracic surgery recovery unit: A propensity score-matched analysis

BACKGROUND

It remains unclear whether enteral nutrition (EN) has an impact on prognosis and immune nutritional status for patients in the cardiothoracic surgery recovery unit (CSRU). We hypothesized that only patients with specific characteristics would benefit from EN and aimed to distinguish that specific population by examining a large database.

METHODS

Propensity-score matching (PSM) was used to eliminate the baseline imbalances between the EN and non-EN groups. The modified nutritional risk in the critically ill (mNUTRIC) score was used to assess the severity of patients' disease as well as their nutritional risk. Kaplan-Meier curves were used to compare the differences in 28- and 1000-day overall survival in the two groups after PSM. Generalized additive mixed models (GAMMs) were used to show dynamic changes in neutrophil-to-lymphocyte ratios (NLRs) and platelet-to-lymphocyte ratios (PLRs) in the two groups. Subgroup analysis was used to identify the specific population that could benefit from EN.

RESULTS

A total of 1823 patients (EN group, n = 395; non-EN group, n = 1428) were enrolled; after PSM, 320 pairs of patients remained. EN was found to reduce the 28-day mortality rate (adjusted hazard ratio [HR] = .56; 95% CI, .35-.91; P = .019) of patients, whereas it had no effect on 1000-day survival (adjusted HR = .97; 95% CI, .75-1.25; P = .797). Subgroup analyses indicated that patients with mNUTRIC equal to or greater than 4, body mass index (BMI) 25-30 kg/m², and vasopressor support were more likely to benefit from EN. NLR and PLR in the EN group decreased progressively over time compared with the non-EN group, suggesting that EN might improve clinical outcomes by regulating immune and inflammatory responses.

CONCLUSION

EN may improve the prognosis and immune nutritional status of patients in the CSRU. Patients who might benefit should be actively treated with EN.

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

For patients undergoing abdominal surgery, malnutrition further increases the susceptibility to infection, surgical complications, and mortality. However, there is no standard tool for identifying high-risk groups of malnutrition or exact criteria for the optimal target of nutrition supply. We aimed to identify the nutritional risk in critically ill patients using modified Nutrition Risk in the Critically Ill (mNUTRIC) scores and assessing the relationship with clinical outcomes. Furthermore, we identified the ideal target of energy intake during the acute postoperative period. A prospective observational study was conducted. mNUTRIC scores and the average calories prescribed and given were calculated. To identify the high-risk group of malnutrition, receiver operating characteristic curves were plotted. The ideal target of energy adequacy and predisposing factors of 90-day mortality were assessed using multiple logistic regression analyses. A total of 206 patients were analyzed. The cutoff value for mNUTRIC score predicting 90-day mortality was 5 (Area under the curve = 0.7, 95% confidence interval (Cl) 0.606−0.795, p < 0.001). A total of 75 patients (36.4%) were classified in the high mNUTRIC group (mNUTRIC ≥ 5) and had a significantly higher postoperative complication and longer length of surgical intensive care unit stay. High mNUTRIC scores (odds ratio = 2.548, 95% CI 1.177−5.514, p = 0.018) and energy adequacy less than 50% (odds ratio = 6.427, 95% CI 1.674−24.674, p = 0.007) were associated with 90-day mortality.