Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients-A multicenter prospective cohort study

Abstract

Purpose: Characterize the nutritional risk of critically ill patients with the modified NUTrition Risk in the Critically ill (NUTRIC) score.

Materials: National, multicenter, prospective, observational study conducted in 15 polyvalent Portuguese intensive care unit (ICU), during 6 months. Adult patients were eligible. Those transferred from another ICU or readmitted, brain dead at admission, and with length of ICU stay (LOS) of 72 hours or less were excluded. NUTRIC score was calculated at admission; scores ≥5 represent a high nutritional risk. Main outcome was mortality from all causes at 28 days after admission to the ICU; LOS and days without mechanical ventilation (days free of MV) were secondary outcomes.

Results: From 2061 admissions, 1143 patients were considered, mostly males (n = 744, 64.7%) with median (P₂₅-P₇₅) age of 64 (51-75). Patients at high nutritional risk were 555 (48.6%). High NUTRIC score was associated with longer LOS (P < .001), less days free of MV (P = .002) and higher 28-day mortality (P < .001). The area under the curve of NUTRIC score ≥5 for predicting 28-day mortality was 0.658 (95% CI, 0.620-0.696). NUTRIC score ≥5 had a positive predictive value 32.7% and a negative predictive value 88.8% for 28-day mortality.

Conclusions: Almost half of the patients in Portuguese ICUs are at high nutritional risk. NUTRIC score was strongly associated with main clinical outcomes.

Keywords: Critically ill; Cultural validation; Effectiveness; Modified NUTRIC score; Nutritional risk.