Comparison of NRS-2002 and mNUTRIC scores to assess nutritional risk and predict medical intensive care unit mortality: A prospective observational study

Abstract

Aim: The intensive care unit (ICU) treats patients with diverse diagnoses, yet no gold-standard tool exists to assess nutritional risk and predict mortality. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommend the use of the Nutritional Risk Screening-2002 (NRS-2002) and the modified Nutrition Risk in the Critically Ill score (mNUTRIC). This study aimed to determine nutritional risk using these tools and compare their performance in predicting ICU mortality. Methods: This cross-sectional study included 201 patients aged ≥18 years treated in the Medical ICU of Adana City Training and Research Hospital between April and October 2022. Patients were classified as survivors or non-survivors and followed until discharge or death. Nutritional risk was assessed using NRS-2002 and mNUTRIC, and their predictive performance for mortality was evaluated using receiver operating characteristic (ROC) analysis. Results: Among 201 patients (57.7% male, mean age 63.06±17.52 years), nutritional risk was identified in 81.6% by NRS-2002 and 25.9% by mNUTRIC. The ICU mortality rate was 45.8% (n=92). Non-survivors had significantly higher median NRS-2002 [4.5 (2–7)] and mNUTRIC [5 (1–9)] scores compared with survivors (p<0.001). The area under the ROC curve (AUC) for predicting mortality was 0.792 (95% CI: 0.732–0.849) for NRS-2002 and 0.851 (95% CI: 0.796–0.901) for mNUTRIC (p<0.05). Optimal cutoff values were >4 for NRS-2002 and >5 for mNUTRIC. Conclusion: Both NRS-2002 and mNUTRIC identified patients at nutritional risk and predicted ICU mortality. The mNUTRIC score demonstrated superior predictive accuracy. Cutoff values of ≥4 for NRS-2002 and ≥5 for mNUTRIC may serve as useful predictors of ICU mortality.

Keywords

• intensive care unit
• nutritional status
• NRS-2002
• mNUTRIC score

Beslenme riskini değerlendirmek ve dahili yoğun bakım ünitesi mortalitesini öngörmek için NRS-2002 ve mNUTRIC skorlarının karşılaştırılması: Prospektif gözlemsel bir çalışma

Öz

AMAÇ: Yoğun bakım ünitesi (YBÜ) çeşitli tanıları olan hastaları tedavi eder, ancak beslenme riskini değerlendirmek ve mortaliteyi tahmin etmek için altın standart bir araç bulunmamaktadır. Amerikan Parenteral ve Enteral Beslenme Derneği (ASPEN), Beslenme Riski Taraması-2002 (NRS-2002) ve modifiye Edilmiş Kritik Hastalarda Beslenme Riski Skoru (mNUTRIC) kullanımını önermektedir. Bu çalışma, bu araçları kullanarak beslenme riskini belirlemeyi ve yoğun bakım ünitesinde mortaliteyi tahmin etmedeki performanslarını karşılaştırmayı amaçlamıştır. Yöntemler: Bu kesitsel çalışma, Nisan ve Ekim 2022 tarihleri arasında Adana Şehir Eğitim ve Araştırma Hastanesi Tıbbi Yoğun Bakım Ünitesinde tedavi gören 18 yaş ve üzeri 201 hastayı içermektedir. Hastalar hayatta kalanlar ve hayatta kalamayanlar olarak sınıflandırılmış ve taburcu olana veya ölene kadar takip edilmiştir. Beslenme riski NRS-2002 ve mNUTRIC kullanılarak değerlendirilmiş ve mortaliteyi öngörme performansları alıcı işletim karakteristiği (ROC) analizi kullanılarak değerlendirilmiştir. Sonuçlar: 201 hasta (57,7% erkek, ortalama yaş 63,06±17,52) arasında, NRS-2002 ile %81,6'sında ve mNUTRIC ile %25,9'unda beslenme riski tespit edildi. Yoğun bakım ünitesi mortalite oranı %45,8 (n=92) idi. Hayatta kalamayanların medyan NRS-2002 [4,5 (2–7)] ve mNUTRIC [5 (1–9)] puanları, hayatta kalanlara kıyasla anlamlı olarak daha yüksekti (p<0,001). Mortaliteyi tahmin etmek için ROC eğrisinin altındaki alan (AUC), NRS-2002 için 0,792 (95% CI: 0,732–0,849) ve mNUTRIC için 0,851 (95% CI: 0,796–0,901) idi (p<0,05). Optimal kesme değerleri NRS-2002 için >4 ve mNUTRIC için >5 idi. Sonuç: Hem NRS-2002 hem de mNUTRIC, beslenme riski altındaki hastaları belirledi ve yoğun bakım ünitesi mortalitesini öngördü. mNUTRIC skoru, üstün öngörü doğruluğu gösterdi. NRS-2002 için ≥4 ve mNUTRIC için ≥5 kesme değerleri, yoğun bakım ünitesi mortalitesinin yararlı öngörücüleri olarak kullanılabilir.

Anahtar Kelimeler

• yoğun bakım ünitesi
• beslenme durumu
• NRS-2002
• mNUTRIC skor

Kaynakça

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