Evaluation of Modified Nutrition Risk in Critically-ill Scoring System as an Assessment and Predictive Tool in Critically-ill Surgical Patients

Document Type : Original Article

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Department of Anesthesia, Intensive Care and Pain Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

Abstract

Background: Several nutritional screening tools have been developed for nutritional risk assessment but no specific tool was identified for critically ill patients. Although the mNUTRIC score was developed for nutritional risk assessment in critically ill patients, data on nutritional risk assessment in critically ill surgical patients using mNUTRIC score are limited.
Aim of the study: This study aims to evaluate the prognostic capacity of the m-NUTRIC score and evaluation of its ability to recognize patients with high nutritional risk who are expected to benefit from aggressive energy and protein provision.
Patients and Methods: Our prospective non-randomized study that included 100 patients admitted postoperatively to our ICU. Data were collected on m-NUTRIC score within 48-72 hours after ICU admission and then patients were classified according to m-NUTRIC score into high risk group with mNUTRIC score >4 (n=12, 12%) and low risk group with m-NUTRIC score ≤4 (n=88, 88%). Both groups were followed up for at least 30 days period to identify their outcomes in the form of 30-day mortality, mechanical ventilation duration, duration of using vasopressor and ICU length of stay to study the association between high m-NUTRIC score and poor outcomes to evaluate its predictive capacity and prognostic performance. 
Results: mNUTRIC cut-off score of > 4 was reported in most of the previous studies, however from our analysis the cut-off value of > 3 showed higher significant specificity and sensitivity. mNUTRIC score over 3 was associated with higher 30-day mortality rate (AUC=0.835, Sensitivity=79%, Specificity=72%, P=0.001), longer MV (AUC=0.679, Sensitivity=61%, Specificity=65%, P=0.018) and vasopressor duration (AUC=0.717, Sensitivity=71%, Specificity=67%, P=0.001)..
Conclusion: m-NUTRIC score can be used as an initial screening tool for nutritional assessment in patients admitted to surgical ICU and can be used as an assessment tool to identify critically ill surgical patients most likely to benefit from additional energy and protein provision.

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