Nutritional assessment of critically ill patients: validation of the modified NUTRIC score

Manon Ch de Vries, Wac Kristine Koekkoek, Marieke H Opdam, Dick van Blokland, Arthur Rh van Zanten, Manon Ch de Vries, Wac Kristine Koekkoek, Marieke H Opdam, Dick van Blokland, Arthur Rh van Zanten

Abstract

Background/objectives: In order to identify critically ill patients with high nutritional risk the modified NUTrition Risk in the Critically ill (mNUTRIC)-score was developed. This score aims to identify patients that will benefit from nutritional interventions. Few data are available on its validity. In The Netherlands, the MUST-score, a nutritional assessment tool for non-ICU patients, is commonly used in the ICU. To validate the mNUTRIC-score in Dutch ICU patients and compare its prognostic performance with the MUST-score.

Subjects/methods: A single-center retrospective cohort study among 475 mechanically ventilated patients. Prognostic performance of the mNUTRIC and MUST-scores were assessed and compared for discriminative abilities for 28-day mortality and prolonged mechanical ventilation (>2 days).

Results: The discriminative ability of the mNUTRIC-score for 28-day mortality is (ROC-AUC) 0.768 (95% CI 0.722-0.814) with an associated LR+ of 1.73 (95% CI 1.53-1.95) and LR- of 0.24 (95% CI 0.14-0.39) when comparing low with high (>4) scores. Comparing low with high MUST-scores (>1) a ROC-AUC of 0.513 (95% CI 0.445-0.587) and LR+ of 1.05 (95%CI 0.77-1.45) and LR- of 0.97 (95% CI 0.71-1.17) for mortality were found. The discriminative ability for prolonged ventilation was 0.666 (95% CI 0.616-0.716) and 0.532 (95% CI 0.469-0.594) for the mNUTRIC and MUST-scores, respectively.

Conclusions: The prognostic performance of the mNUTRIC-score for 28-day mortality is fair and comparable to other validation studies. The association with prolonged ventilation was not confirmed by our results. The mNUTRIC-score has better performance than the commonly used MUST-score. Therefore, we suggest abandoning use of the MUST-score and to recommend introduction of the mNUTRIC-score for the nutritional risk assessment of critically ill patients.

Conflict of interest statement

Dr van Zanten reported that he has received honoraria for advisory board meetings, lectures, and travel expenses from Abbott, Baxter, BBraun, Danone-Nutricia, Fresenius Kabi, Nestle-Novartis, and Lyric. Inclusion fees for patients in nutrition trials were paid to the local ICU research foundation. There are no funds to declare. Drs de Vries, Drs Koekkoek, Drs Opdam, and Mr Van Blokland declare to have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of validation cohort
Fig. 2
Fig. 2
NUTRIC-scores and 28 days mortality. NUTRIC predicted, first bar, is a predicted value, no patients. Heyland et al. [6], middle bar, with number of patient (N), Ede, last bar, number of patients (N) per NUTRIC score category
Fig. 3
Fig. 3
NUTRIC-scores and observed duration of ventilation. NUTRIC predicted, first bar, is a predicted value, no patients. Heyland et al. [6], middle bar, with number of patient (N), Ede, last bar, number of patients (N) per NUTRIC score category

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Source: PubMed

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