Prediction of mortality in patients admitted to the intensive care unit due to respiratory failure; use of nutritional screening tools mNUTRIC and NRS-2002

Year 2025, Volume: 7 Issue: 2, 111 - 119, 21.03.2025

Onur Küçük , Fatih Seğmen , Semih Aydemir

https://doi.org/10.38053/acmj.1608252

Abstract

Aims: The objective of this study was to examine the effectiveness of the nutritional screening tools modified nutrition risk in the critically ill (mNUTRIC) and nutrition risk screening-2002 (NRS-2002) in predicting mortality among patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) and to determine if their effectiveness varies by respiratory failure (RF) type.
Methods: This prospective, cohort, descriptive study was initiated after ethics committee approval. During a 6-month period, all adult patients (aged ≥18 years) admitted to the tertiary ICUs with acute RF, with type 1 and type 2 RF, who stayed for more than 48 hours were included. Patients were divided into two groups: survivors and non-survivors. Nutritional screening was performed with mNUTRIC and NRS-2002. Scores of 5 points or more on any of the nutritional tools were considered to indicate high nutritional risk. Multiple logistic regression analysis was used to test data predicting 1-month (30-day) and 3-month (90-day) mortality. Relative risk (RR) values of the nutritional tools on mortality were calculated.
Results: Among 525 patients, 35.4% had type 1 RF, and 64.6% had type 2 RF. The mortality rates were 44.2% at one month and 62.5% at three months, with higher mortality observed in type 1 RF in both periods. The mNUTRIC score, the presence of inotropic support, type 1 RF, and admission from the ward were identified as independent variables with a significant association with mortality at 1 and 3 months. The mNUTRIC score emerged as the variable most strongly associated with mortality in both periods. When the mNUTRIC score was evaluated in isolation, the optimal cut-off value was determined to be 6 (1-month mortality AUC: 0.77, 3-month mortality AUC: 0.82). Patients with nutritional risk, as identified by mNUTRIC, exhibited a fourfold elevated risk of mortality within one month (RR=4.2; 95% CI: 2.56–6.95; p<.001) and three months (RR=4.6; 95% CI: 3.04–7.15; p<.001). Combining mNUTRIC and NRS-2002 scores did not significantly enhance predictive accuracy compared to mNUTRIC alone.
Conclusion: In patients with RF, the mNUTRIC score is the most powerful parameter for identifying the high-risk group. The prognosis is worse in patients with type 1 RF compared to type 2. Especially in the group of patients with high mNUTRIC score, in need of inotropic support, type 1 RF findings, and the need for ICU during hospitalization, early intervention and management in terms of nutrition is important to improve the duration of intensive care stay and mortality rates.

Keywords

Acute respiratory failure, intensive care unit, mortality, mNUTRIC, NRS-2002

Ethical Statement

Approval was obtained from the ethics committee at the Health Sciences University, Ankara Atatürk Sanatoryum Training and Research Hospital (date: 08.02.2023; approval no.: 2012-KAEK-15/2627 and clinicaltrials.gov registration number: NCT06115525). Informed consent was obtained from all participants or their first-degree relatives. All procedures followed were in accordance with the ethical standards (institutional and national) of the committee responsible for human experiments and the 1975 Declaration of Helsinki, revised in 2013.

Supporting Institution

None.

Thanks

Endless thanks to the nutritional team and intensive care team of our hospital who supported us during our study.

Solunum yetmezliği nedeniyle yoğun bakım ünitesine kabul edilen hastalarda mortalite tahmini; beslenme tarama araçları mNUTRIC ve NRS-2002'nin kullanımı

Abstract

Amaç: Bu çalışmanın amacı, Kritik Hastalarda Modifiye Beslenme Riski (mNUTRIC) ve Beslenme Riski Taraması-2002 (NRS-2002) beslenme tarama araçlarının solunum yetmezliği (SY) ile yoğun bakım ünitesine (YBÜ) kabul edilen hastalarda mortaliteyi tahmin etmedeki etkinliğini ve bu etkinliğin SY tipine göre değişip değişmediğini incelemektir.
Yöntemler: Bu prospektif, kohort, tanımlayıcı çalışma etik kurul onayından sonra başlatıldı. Altı aylık bir süre boyunca, üçüncü basamak YBÜ'lere akut SY ile kabul edilen, tip 1 ve tip 2 SY olan ve 48 saatten fazla kalan tüm yetişkin hastalar (≥18 yaş) dahil edildi. Hastalar hayatta kalanlar ve hayatta kalmayanlar olmak üzere iki gruba ayrıldı. Beslenme taraması mNUTRIC ve NRS-2002 ile yapıldı. Beslenme araçlarından herhangi birinden alınan 5 puan veya üzeri skorlar yüksek beslenme riski göstergesi olarak kabul edildi. Çoklu lojistik regresyon analizi, 1 aylık (30 günlük) ve 3 aylık (90 günlük) mortaliteyi öngören verileri test etmek için kullanıldı. Beslenme araçlarının mortalite üzerindeki rölatif risk (RR) değerleri hesaplandı.
Sonuçlar: Çalışma popülasyonu akut SY ile başvuran 525 hastadan oluşmaktaydı ve bunların %35,4'ünde tip 1 SY ve %64,6'sında tip 2 SY vardı. Mortalite oranları bir ayda %44,2 ve üç ayda %62,5 olup her iki dönemde de tip 1 SY'de daha yüksek mortalite gözlendi. mNUTRIC skoru, inotropik destek varlığı, tip 1 SY ve servisten kabul, 1. ve 3. aylarda mortalite ile anlamlı ilişkisi olan bağımsız değişkenler olarak tanımlandı. mNUTRIC skoru her iki dönemde de mortalite ile en güçlü şekilde ilişkili değişken olarak saptandı. mNUTRIC skoru tek başına değerlendirildiğinde, optimum kesme değeri 6 olarak belirlendi. mNUTRIC tarafından tanımlanan beslenme riski olan hastalarda, bir ay ve üç ay içinde dört kat daha yüksek mortalite riski saptandı.
Sonuç: SY'li hastalarda, mNUTRIC skoru yüksek riskli grubu tanımlamak için en güçlü parametredir. Tip 1 SY'li hastalarda prognoz tip 2'ye kıyasla daha kötüdür. Özellikle mNUTRIC skoru yüksek, inotropik desteğe ihtiyaç duyan, tip 1 SY bulguları olan ve servis yatışı sırasında YBÜ ihtiyacı doğan hasta grubunda beslenme açısından erken müdahale ve yönetim, yoğun bakımda kalış süresini ve mortalite oranlarını iyileştirmek için önemlidir.

Keywords

akut solunum yetmezliği, yoğun bakım ünitesi, mortalite, mNUTRIC, NRS-2002

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