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For: Kalaiselvan MS, Renuka MK, Arunkumar AS. Use of Nutrition Risk in Critically ill (NUTRIC) Score to Assess Nutritional Risk in Mechanically Ventilated Patients: A Prospective Observational Study. Indian J Crit Care Med 2017;21:253-256. [PMID: 28584426 PMCID: PMC5455016 DOI: 10.4103/ijccm.ijccm_24_17] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open

For:	Kalaiselvan MS, Renuka MK, Arunkumar AS. Use of Nutrition Risk in Critically ill (NUTRIC) Score to Assess Nutritional Risk in Mechanically Ventilated Patients: A Prospective Observational Study. Indian J Crit Care Med 2017;21:253-256. [PMID: 28584426 PMCID: PMC5455016 DOI: 10.4103/ijccm.ijccm_24_17] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open

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Cited by Other Article(s)

Nakamura K, Yamamoto R, Higashibeppu N, Yoshida M, Tatsumi H, Shimizu Y, Izumino H, Oshima T, Hatakeyama J, Ouchi A, Tsutsumi R, Tsuboi N, Yamamoto N, Nozaki A, Asami S, Takatani Y, Yamada K, Matsuishi Y, Takauji S, Tampo A, Terasaka Y, Sato T, Okamoto S, Sakuramoto H, Miyagi T, Aki K, Ota H, Watanabe T, Nakanishi N, Ohbe H, Narita C, Takeshita J, Sagawa M, Tsunemitsu T, Matsushima S, Kobashi D, Yanagita Y, Watanabe S, Murata H, Taguchi A, Hiramoto T, Ichimaru S, Takeuchi M, Kotani J. The Japanese Critical Care Nutrition Guideline 2024. J Intensive Care 2025;13:18. [PMID: 40119480 PMCID: PMC11927338 DOI: 10.1186/s40560-025-00785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 02/23/2025] [Indexed: 03/24/2025] Open

Abstract

Nutrition therapy is important in the management of critically ill patients and is continuously evolving as new evidence emerges. The Japanese Critical Care Nutrition Guideline 2024 (JCCNG 2024) is specific to Japan and is the latest set of clinical practice guidelines for nutrition therapy in critical care that was revised from JCCNG 2016 by the Japanese Society of Intensive Care Medicine. An English version of these guidelines was created based on the contents of the original Japanese version. These guidelines were developed to help health care providers understand and provide nutrition therapy that will improve the outcomes of children and adults admitted to intensive care units or requiring intensive care, regardless of the disease. The intended users of these guidelines are all healthcare professionals involved in intensive care, including those who are not familiar with nutrition therapy. JCCNG 2024 consists of 37 clinical questions and 24 recommendations, covering immunomodulation therapy, nutrition therapy for special conditions, and nutrition therapy for children. These guidelines were developed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by experts from various healthcare professionals related to nutrition therapy and/or critical care. All GRADE-based recommendations, good practice statements (GPS), future research questions, and answers to background questions were finalized by consensus using the modified Delphi method. Strong recommendations for adults include early enteral nutrition (EN) within 48 h and the provision of pre/synbiotics. Weak recommendations for adults include the use of a nutrition protocol, EN rather than parenteral nutrition, the provision of higher protein doses, post-pyloric EN, continuous EN, omega-3 fatty acid-enriched EN, the provision of probiotics, and indirect calorimetry use. Weak recommendations for children include early EN within 48 h, bolus EN, and energy/protein-dense EN formulas. A nutritional assessment is recommended by GPS for both adults and children. JCCNG 2024 will be disseminated through educational activities mainly by the JCCNG Committee at various scientific meetings and seminars. Since studies on nutritional treatment for critically ill patients are being reported worldwide, these guidelines will be revised in 4 to 6 years. We hope that these guidelines will be used in clinical practice for critically ill patients and in future research.

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Affiliation(s)

Kensuke Nakamura Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
Ryo Yamamoto Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
Naoki Higashibeppu Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan
Minoru Yoshida Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
Hiroomi Tatsumi Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
Yoshiyuki Shimizu Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
Hiroo Izumino Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
Taku Oshima Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba City, Japan
Junji Hatakeyama Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
Akira Ouchi Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi, Japan
Rie Tsutsumi Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan
Norihiko Tsuboi Department of Critical Care Medicine and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
Natsuhiro Yamamoto Department of Anesthesiology and Critical Care Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
Ayumu Nozaki Department of Pharmacy, Kyoto-Katsura Hospital, Kyoto, Japan
Sadaharu Asami Department of Cardiology, Musashino Tokushukai Hospital, Tokyo, Japan
Yudai Takatani Department of Primary Care and Emergency Medicine, Kyoto University Hospital, Kyoto, Japan
Kohei Yamada Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, Saitama, Japan
Yujiro Matsuishi Adult and Elderly Nursing, Faculty of Nursing, Tokyo University of Information Science, Chiba, Japan
Shuhei Takauji Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
Akihito Tampo Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
Yusuke Terasaka Department of Emergency Medicine, Kyoto Katsura Hospital, Kyoto, Japan
Takeaki Sato Tohoku University Hospital Emergency Center, Miyagi, Japan
Saiko Okamoto Department of Nursing, Hitachi General Hospital, Hitachi, Japan
Hideaki Sakuramoto Department of Acute Care Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
Tomoka Miyagi Anesthesiology and Critical Care Medicine, Master's Degree Program, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
Keisei Aki Department of Pharmacy, Kokura Memorial Hospital, Fukuoka, Japan
Hidehito Ota Department of Pediatrics, School of Medicine, The University of Tokyo, Tokyo, Japan
Taro Watanabe Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
Nobuto Nakanishi Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
Hiroyuki Ohbe Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Japan
Chihiro Narita Department of Emergency Medicine, Shizuoka General Hospital, Shizuoka, Japan
Jun Takeshita Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan
Masano Sagawa Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
Takefumi Tsunemitsu Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Shinya Matsushima Department of Physical Therapy, Faculty of Health Science, Kyorin University, Tokyo, Japan
Daisuke Kobashi Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, Gunma, Japan
Yorihide Yanagita Department of Health Sciences, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
Shinichi Watanabe Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
Hiroyasu Murata Department of Rehabilitation Medicine, Kyorin University Hospital, Tokyo, Japan
Akihisa Taguchi Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
Takuya Hiramoto Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
Satomi Ichimaru Food and Nutrition Service Department, Fujita Health University Hospital, Aichi, Japan
Muneyuki Takeuchi Department of Critical Care Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
Joji Kotani Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan

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Lopes MLG, Cidade JP, Sousa D, Rebelo M, Antunes C, Carmo E, Póvoa P, Martins P, Limbert C, Duarte JS. Ultrasound assessment of muscle mass in critically ill patients: A correlation with nutritional support and clinical outcomes. J Crit Care 2025;85:154938. [PMID: 39427571 DOI: 10.1016/j.jcrc.2024.154938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 09/25/2024] [Accepted: 10/14/2024] [Indexed: 10/22/2024]

Siaw-Frimpong M, Korula PJ, Karuppusami R, Gyapon NF, Subramani K, Chander RU, Rao S, Addison W. Combined Effect of the Timing of Initiation of Nutrition and Nutrition Risk on Outcomes in a Mixed Intensive Care Unit of a Tertiary Hospital in a Middle-income Country. Indian J Crit Care Med 2025;29:137-142. [PMID: 40110154 PMCID: PMC11915452 DOI: 10.5005/jp-journals-10071-24891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 12/24/2024] [Indexed: 03/22/2025] Open

Abstract

Background

The importance of nutrition in the critically ill is well known but its practice is varied globally. Determining the nutrition risk is important to help improve outcomes.

Materials and methods

A prospective observational study involved patients admitted to the intensive care unit (ICU) who stayed for at least 48 hours. The demographics of participants modified the NUTRIC score, and comorbidities were assessed. The timing of nutrition initiation was noted to get two main cohorts: Early (within 48 hours of admission) and delayed (after 48 hours of admission). All the patients were followed for a maximum of 30 days in the hospital to determine outcome variables such as mortality and length of hospital stay. The ICU-free days (30 minus days in ICU) and 30-day hospital-free days were calculated and recorded for each patient.

Results

A total of 489 patients, 59.9% were males, 75.5% were mechanically ventilated and total parenteral nutrition utilization was 13.2%. The prevalence of nutrition risk was 21.1%. The patients who had early nutrition constituted 36.6%. There was no difference in the primary outcome of ICU-free days between the two groups; 24 (19-25.5) and 24 (16-25) days, respectively; p = 0.591. The high modified NUTRIC score cohort had lower ICU-free days (p < 0.001), 30-day hospital-free days, and higher mortality; 18 (0-24) vs 25 days (20-26), p < 0.001.

Conclusion

The timing of the initiation of nutrition does not affect ICU-free days and 30-day hospital-free days irrespective of the nutrition risk on admission. A high modified NUTRIC score is associated with reduced ICU-free days and 30-day hospital-free days and increased mortality.

How to cite this article

Siaw-Frimpong M, Korula PJ, Karuppusami R, Gyapon NF, Subramani K, Chander RU, et al. Combined Effect of the Timing of Initiation of Nutrition and Nutrition Risk on Outcomes in a Mixed Intensive Care Unit of a Tertiary Hospital in a Middle-income Country. Indian J Crit Care Med 2025;29(2):137-142.

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Toscano A, Bellone F, Maggio N, Cinquegrani M, Spadaro F, Bueti FM, Lorello G, Marini HR, Lo Gullo A, Basile G, Squadrito G, Mandraffino G, Morace C. Unlocking the Predictive Power of Nutritional Scores in Septic Patients. Nutrients 2025;17:545. [PMID: 39940402 PMCID: PMC11820051 DOI: 10.3390/nu17030545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 01/24/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open

Abstract

Background: Sepsis is a critical condition characterized by severe immune dysregulation, ranking among the leading causes of morbidity and mortality in intensive care and internal medicine units. Nutritional status plays a pivotal role in modulating these responses, as when inadequate it can compromise immune defenses, the body's ability to handle stress and inflammation, and the clinical course. Malnutrition is frequently observed in septic patients and is strongly associated with worse clinical outcomes, including increased mortality, prolonged hospital stays, and greater complication rates. In this context, nutritional scoring systems have emerged as valuable tools to evaluate patients' nutritional status and predict clinical trajectories. Objectives: Given the absence of a direct comparison of their performance in an internal medicine setting, this study aimed to assess the effectiveness of various nutritional scores as predictive tools for clinical outcomes in septic patients, emphasizing their application within the field of internal medicine. Methods and Results: A retrospective analysis was conducted on 143 patients diagnosed with sepsis or septic shock who were admitted to an internal medicine unit. Key variables included clinical and laboratory parameters, comorbidities, and nutritional scores at the time of diagnosis. The modified Glasgow Prognostic Score (mGPS), the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, the modified Nutrition Risk in Critically Ill (mNUTRIC) score, and the blood urea nitrogen-to-albumin ratio (BAR) were evaluated in forecasting mortality and clinical outcomes in patients with sepsis. Among them, the mNUTRIC score emerged as the strongest independent predictor of in-hospital mortality, with a good performance and a reasonable threshold for risk stratification. Conclusions: The study highlights the mNUTRIC score's practicality and reliability in assessing nutritional and inflammatory risks in septic patients, particularly in non-ICU settings. These findings suggest its potential utility in guiding nutritional interventions and improving clinical outcomes, emphasizing the importance of integrating nutritional assessment into sepsis management.

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Affiliation(s)

Arianna Toscano Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Federica Bellone Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Noemi Maggio Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Maria Cinquegrani Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Francesca Spadaro Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Francesca Maria Bueti Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Giuseppe Lorello Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Herbert Ryan Marini Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Alberto Lo Gullo Unit of Rheumatology, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
Giorgio Basile Unit of Geriatrics, Department of Biomedical and Dental Science and Morphofunctional Imaging, University Hospital G. Martino, University of Messina, 98100 Messina, Italy;
Giovanni Squadrito Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Giuseppe Mandraffino Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)
Carmela Morace Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University Hospital G. Martino, University of Messina, 98100 Messina, Italy; (A.T.); (F.B.); (N.M.); (M.C.); (F.S.); (F.M.B.); (G.L.); (H.R.M.); (G.S.); (C.M.)

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van Ee EPX, Verheul EAH, Dijkink S, Krijnen P, Veldhuis W, Feshtali SS, Avery L, Lucassen CJ, Mieog SD, Hwabejire JO, Schipper IB. The correlation of CT-derived muscle density, skeletal muscle index, and visceral adipose tissue with nutritional status in severely injured patients. Eur J Trauma Emerg Surg 2024;50:3209-3215. [PMID: 39167212 PMCID: PMC11666640 DOI: 10.1007/s00068-024-02624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]

Verheul EA, Dijkink S, Krijnen P, Verhoeven A, Giera M, Tsonaka R, Hoogendoorn JM, Arbous SM, Peters R, Schipper IB. Relevance of plasma lipoproteins and small metabolites in assessment of nutritional status among patients with severe injuries. JOURNAL OF INTENSIVE MEDICINE 2024;4:496-507. [PMID: 39310068 PMCID: PMC11411433 DOI: 10.1016/j.jointm.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 09/25/2024]

Abstract

Background

This study aimed to identify plasma lipoproteins and small metabolites associated with high risk of malnutrition during intensive care unit (ICU) stay in patients with severe injuries.

Methods

This observational prospective exploratory study was conducted at two level-1 trauma centers in the Netherlands. Adult patients (aged ≥18 years) who were admitted to the ICU for more than 48 h between July 2018 and April 2022 owing to severe injuries (polytrauma, as defined by Injury Severity Scores of ≥16) caused by blunt trauma were eligible for inclusion. Partial least squares discriminant analysis was used to analyze the relationship of 112 lipoprotein-related components and 23 small metabolites with the risk of malnutrition (modified Nutrition Risk in Critically Ill score). Malnutrition was diagnosed based on Subjective Global Assessment scores. The relationship of lipoprotein properties and small metabolite concentrations with malnutrition (during ICU admission) was evaluated using mixed effects logistic regression.

Results

Overall, 51 patients were included. Lower (very) low-density lipoprotein ([V]LDL) (free) cholesterol and phospholipid levels, low particle number, and higher levels of LDL triglycerides were associated with a higher risk of malnutrition (variable importance in projection [VIP] value >1.5). Low levels of most (V)LDL and intermediate-density lipoprotein subfractions and high levels of high-density lipoprotein Apo-A1 were associated with the diagnosis of malnutrition (VIP value >1.5). Increased levels of dimethyl sulfone, trimethylamine N-oxide, creatinine, N, N-dimethylglycine, and pyruvic acid and decreased levels of creatine, methionine, and acetoacetic acid were also indicative of malnutrition (VIP value >1.5). Overall, 14 lipoproteins and 1 small metabolite were significantly associated with a high risk of malnutrition during ICU admission (P <0.05); however, the association did not persist after correcting the false discovery rate (P=0.35 for all).

Conclusion

Increased triglyceride in several lipoprotein subfractions and decreased levels of other lipoprotein subfraction lipids and several small metabolites (involved in the homocysteine cycle, ketone body formation, and muscle metabolism) may be indicative of malnutrition risk. Following validation in larger cohorts, these indicators may guide institution of preventive nutritional measures in patients admitted to the ICU with severe injuries.

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Verheul EAH, Horzum E, Dijkink S, Krijnen P, Hoogendoorn JM, Arbous SM, Peters R, Schipper IB. Fat-soluble vitamins as biomarkers of nutritional status and their relation with complications in polytrauma patients. Nutr Health 2024:2601060241273640. [PMID: 39155642 DOI: 10.1177/02601060241273640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]

Hai PD, Tot NH, Thao LT, Khoa Q, Thien DH. Prognostic Value of Acute Gastrointestinal Injury Combined with Disease Severity Scores in Critically Ill Patients. Indian J Crit Care Med 2024;28:575-580. [PMID: 39130390 PMCID: PMC11310679 DOI: 10.5005/jp-journals-10071-24733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/03/2024] [Indexed: 08/13/2024] Open

Abstract

Background

Critically ill patients are at high risk of multiple organ failure syndrome (MODS) and gastrointestinal (GI) injury and dysfunction, which are associated with increased mortality rates. The acute gastrointestinal injury (AGI) scale has shown promise in assessing GI dysfunction. However, the combined utility of AGI with established disease severity scores remains unclear. This study aimed to investigate the performance of AGI in conjunction with modified nutritional risk in critically ill (mNUTRIC), sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE II) scores for predicting mortality in critically ill patients.

Materials and methods

A retrospective cross-sectional study was conducted in the intensive care unit (ICU) from May 2021 to December 2021. Demographic and clinical data were collected, including AGI grade, mNUTRIC score, SOFA score, APACHE II score, and mortality.

Results

Among 93 critically ill patients, AGI was observed in 47.3% of cases, and the in-hospital mortality rate was 30.1%. The area under the curve (AUC) for AGI in predicting in-hospital mortality was 0.67 [95% confidence interval (CI), 0.56, 0.79; p = 0.008], similar to the AUCs of SOFA, APACHE II, and mNUTRIC scores. The combination of AGI with mNUTRIC, APACHE II, or SOFA scores improved the predictive performance compared with AGI alone.

Conclusion

The AGI grade, in conjunction with disease severity scores, such as mNUTRIC, SOFA, and APACHE II scores, shows promise in predicting mortality in critically ill patients. Integrating AGI into evaluating critically ill patients can enhance prognostic accuracy.

How to cite this article

Hai PD, Tot NH, Thao LT, Khoa Q, Thien DH. Prognostic Value of Acute Gastrointestinal Injury Combined with Disease Severity Scores in Critically Ill Patients. Indian J Crit Care Med 2024;28(6):575-580.

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Prakash J, Verma S, Shrivastava P, Saran K, Kumari A, Raj K, Kumar A, Ray HN, Bhattacharya PK. Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28:495-503. [PMID: 38738192 PMCID: PMC11080097 DOI: 10.5005/jp-journals-10071-24706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/04/2024] [Indexed: 05/14/2024] Open

Guan X, Chen D, Xu Y. Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China. JOURNAL OF INTENSIVE MEDICINE 2024;4:137-159. [PMID: 38681796 PMCID: PMC11043647 DOI: 10.1016/j.jointm.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 05/01/2024]

De Rosa S, Greco M, Rauseo M, Annetta MG. The Good, the Bad, and the Serum Creatinine: Exploring the Effect of Muscle Mass and Nutrition. Blood Purif 2023;52:775-785. [PMID: 37742621 PMCID: PMC10623400 DOI: 10.1159/000533173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023]

Mahmoodpoor A, Sanaie S, Sarfaraz T, Shadvar K, Fattahi V, Hamishekar H, Vahedian-Azimi A, Samim A, Rahimi-Bashar F. Prognostic values of modified NUTRIC score to assess outcomes in critically ill patients admitted to the intensive care units: prospective observational study. BMC Anesthesiol 2023;23:131. [PMID: 37081414 PMCID: PMC10116464 DOI: 10.1186/s12871-023-02086-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023] Open

Wełna M, Adamik B, Kübler A, Goździk W. The NUTRIC Score as a Tool to Predict Mortality and Increased Resource Utilization in Intensive Care Patients with Sepsis. Nutrients 2023;15:nu15071648. [PMID: 37049489 PMCID: PMC10097365 DOI: 10.3390/nu15071648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open

Alikiaii B, Hashemi ST, Kiani Z, Heidari Z, Nazemroaya B, Golparvar M, Daneshmanesh S, Fattahpour S, Amini S, Shojaei M, Bagherniya M. Evaluation of the effectiveness of the modified nutrition risk in the critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU). BMC Nutr 2022;8:158. [PMID: 36585718 PMCID: PMC9803259 DOI: 10.1186/s40795-022-00659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open

Abstract

BACKGROUND

COVID-19 is a very harmful pandemic, and its recovery process is highly influenced by nutritional status; however, an appropriate nutritional scale has not yet been proposed for these patients. Therefore, the purpose of this study was to evaluate the effectiveness of the modified Nutrition Risk in the Critically ill (mNUTRIC) score in critically ill patients affected by COVID-19 admitted to the intensive care unit (ICU).

MATERIAL AND METHODS

This was a cross-sectional study performed on 204 critically ill patients affected by COVID-19 admitted to the ICU wards. Evaluated indicators include the mNUTRIC Score as well as demographic, and biochemical indicators.

RESULTS

A high percentage of COVID-19 patients (67.2%) had severe disease. Hospital and ICU stay (p > 0.001) and PH (p > 0.001) values were significantly lower in non-survivors than in survivors. mNUTRIC score (p > 0.001), PCO2 (p = 0.003), and CRP levels (p = 0.021) were significantly higher in non-survivors than survivors. mNUTRIC score had a direct correlation with age (p > 0.001), AST (p = 0.000), LDH (p = 0.026), and CRP (p = 0.014) and an inverse correlation with hospital duration (p = 0.031), albumin (p = 0.003) and PH (p < 0.001). Furthermore, there was a non-significant correlation between the mNUTRIC score and mortality chance (OR = 1.085, 95%CI [0.83, 1.42], p = 0.552). While, patients with more severe COVID-19 disease (OR = 8.057, 95%CI [1.33, 48.64], p = 0.023) and higher PCO2 (OR = 1.042, 95%CI [1.01, 1.08], p = 0.023) levels had higher odds of mortality.

CONCLUSIONS

Our findings revealed that COVID-19 patients with higher CRP levels and lower PH had higher mortality and poor nutritional condition. Moreover, there was a non-significant association between the mNUTRIC score and mortality chance.

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Wang J, Zheng N, Chang X, Qian H, Han Y. Nutritional risk factors for all-cause mortality of critically ill patients: a retrospective cohort study. BMJ Open 2022;12:e066015. [PMID: 36396305 PMCID: PMC9677028 DOI: 10.1136/bmjopen-2022-066015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open

Abstract

OBJECTIVES

This study aimed to explore the predictive value of single and multiple risk factors for the clinical outcomes of critically ill patients receiving enteral nutrition and to establish an effective evaluation model.

DESIGN

Retrospective cohort study.

SETTING

Data from the 2020-2021 period were collected from the electronic records of the First Affiliated Hospital, Nanjing Medical University.

PARTICIPANTS

459 critically ill patients with enteral nutrition in the geriatric intensive care unit were included in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was 28-day mortality. The secondary outcomes were 28-day invasive mechanical ventilation time, intensive care unit stay, Nutrition Risk Screening 2002 (NRS2002) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score.

RESULTS

Independent prognostic factors, including prealbumin/procalcitonin (PCT) ratio and APACHE II score, were identified using a logistic regression model and used in the nomogram. The area under the receiver operating characteristic curve and concordance index indicated that the predictive capacity of the model was 0.753. Moreover, both the prealbumin/PCT ratio and the combination model of PCT, prealbumin and NRS2002 had a higher predictive value for clinical outcomes. Subgroup analysis also identified that a higher inflammatory state (PCT >0.5 ng/mL) and major nutritional risk (NRS2002 >3) led to worse clinical outcomes. In addition, patients on whole protein formulae bore less nutritional risk than those on short peptide formulae.

CONCLUSIONS

This nomogram had a good predictive value for 28-day mortality in critically ill patients receiving enteral nutrition. Both the prealbumin/PCT ratio and the combination model (PCT, prealbumin and NRS2002), as composite models of inflammation and nutrition, could better predict the prognosis of critically ill patients.

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Dsouza M, Nagar VS, Radhakrishnan R, Pai KS, Ireddy VK. Modified Nutrition Risk in Critically Ill Score, A Prognostic Marker of Morbidity and Mortality in Mechanically Ventilated Patients: A Prospective Observational Study. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022;70:11-12. [PMID: 37355945 DOI: 10.5005/japi-11001-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]

Abstract

BACKGROUND

Critically ill (CI) patients, especially those requiring mechanical ventilation (MV) are at a higher risk of malnutrition, which in turn is associated with increased hospitalization and excess mortality. The modified Nutrition Risk in Critically Ill (mNUTRIC) score, a predictor of mortality, has not been validated adequately in CI Indian patients. Thus, this study evaluated the mNUTRIC score as a prognostic marker of morbidity and mortality in CI patients requiring MV.

MATERIALS AND METHODS

This prospective observational study was performed, between January 2018 and June 2019, in the intensive critical care unit (ICCU) of the medicine department of a tertiary care hospital. A total of 250 patients aged above 12 years, admitted in ICCU, and requiring MV for >48 hours were included. Based on the data collected, mNUTRIC score was calculated and patients were classified as at low (0-4) and high (5-9) nutritional risk. Mortality was the outcome variable.

RESULTS

More than a quarter of patients had a high mNUTRIC score (28.4%) and the overall mortality was 35.6%. A significantly greater proportion of non-survivors had a high mNUTRIC score (p-value<0.0001). Likewise, the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and mNUTRIC score (all p-values<0.0001) were significantly higher among the non-survivors than the survivors. On receiver operator characteristic (ROC) curve analysis, a cutoff value of >2 predicted mortality [area under the curve (AUC): 0.83; 95% confidence interval: 0.778-0.874] with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 80.9, 76.4, 65.5, and 87.9%, respectively.

CONCLUSION

At a cutoff of >2, mNUTRIC score had high sensitivity and specificity in the prediction of mortality.

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Nutritional assessment of patients with aneurysmal subarachnoid hemorrhage using the modified "Nutrition Risk in the Critically Ill" score, and its association with outcomes. NUTR HOSP 2022;39:709-715. [PMID: 35916136 DOI: 10.20960/nh.04093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open

Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study. Crit Care Res Pract 2021;2021:5866468. [PMID: 34956677 PMCID: PMC8694949 DOI: 10.1155/2021/5866468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open

Al-Kalaldeh M, Shosha GA, Shoqirat N, Alsaraireh M, Haddadin R. Estimating the time point for nutritional failure in patients suffering from acute brain attacks in the intensive care unit. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021;30:S12-S19. [PMID: 34839686 DOI: 10.12968/bjon.2021.30.21.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]

Risk of Malnutrition and Clinical Outcomes Among Mechanically Ventilated Patients in Intensive Care Units. Dimens Crit Care Nurs 2021;41:18-23. [PMID: 34817957 DOI: 10.1097/dcc.0000000000000504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open

Acehan S, Gulen M, Isıkber C, Unlu N, Sumbul HE, Gulumsek E, Satar S. mNUTRIC tool is capable to predict nutritional needs and mortality early in patients suffering from severe pneumonia. Clin Nutr ESPEN 2021;45:184-191. [PMID: 34620315 PMCID: PMC8441546 DOI: 10.1016/j.clnesp.2021.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 01/04/2023]

İleri İ, Özsürekci C, Halil MG, Gündoğan K. NRS-2002 and mNUTRIC score: Could we predict mortality of hematological malignancy patients in the ICU? Nutr Clin Pract 2021;37:1199-1205. [PMID: 34587327 DOI: 10.1002/ncp.10783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open

Badjatia N, Ryan A, Choi HA, Parikh GY, Jiang X, Day AG, Heyland DK. Relationship Between Nutrition Intake and Outcome After Subarachnoid Hemorrhage: Results From the International Nutritional Survey. J Intensive Care Med 2021;36:1141-1148. [PMID: 34519558 DOI: 10.1177/0885066620966957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]

Abstract

BACKGROUND

A previous study suggested an association between low caloric intake(CI), negative nitrogen balance, and poor outcome after subarachnoid hemorrhage(SAH). Objective of this multinational, multicenter study was to investigate whether clinical outcomes vary by protein intake(PI) or CI in SAH patients adjusting for the nutritional risk as judged by the modified NUTrition Risk in the Critically Ill (mNUTRIC) score.

METHODS

The International Nutrition Survey(INS) 2007-2014 was utilized to describe the characteristics, outcomes and nutrition use. A subgroup of patients from 2013 and 2014(when NUTRIC score was captured) examined the association between CI and PI and time to discharge alive(TTDA) from hospital using Cox regression models, adjusting for nutrition risk classified by the mNUTRIC score as low(0-4) or high(5-9).

RESULTS

There were 489 SAH patients(57% female with a mean ± SD age 57.5 ± 13.9 years, BMI of 25.9 ± 5.3 kg/m² and APACHE-2 score 19.4 ± 7.0. Majority(85%) received enteral nutrition(EN) only, with a time to initiation of EN of 35.4 ± 35.2 hours. 64% had EN interrupted. Patients received a CI of 14.6 ± 7.1 calories/kg/day and PI 0.7 ± 0.3 grams/kg/day corresponding to 59% and 55% of total prescribed CI and PI respectively. In the 2013 and 2014 subgroup there were 226 SAH patients with a mNUTRIC score of 3.4 ± 1.8. Increased CI and PI were associated with faster TTDA among high mNUTRIC patients(HR per 20% of prescription received = 1.34[95% CI,1.03 -1.76] for CI and 1.44[1.07 -1.93] for PI), but not low mNUTRIC patients(CI: HR = 0.95[0.77 -1.16] PI:0.95[0.78 -1.16]).

CONCLUSIONS

Results from this multicenter study found that SAH patients received under 60% of their prescribed CI and PI. Further, achieving greater CI and PI in hi risk SAH patients was associated with improved TTDA. mNUTRIC serves to identify SAH patients that benefit most from artificial nutrition and efforts to optimize protein and caloric delivery in this subpopulation should be maximized.

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Vargas-Mendoza N, García-Machorro J, Angeles-Valencia M, Martínez-Archundia M, Madrigal-Santillán EO, Morales-González Á, Anguiano-Robledo L, Morales-González JA. Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals. World J Gastroenterol 2021;27:5630-5665. [PMID: 34629792 PMCID: PMC8473593 DOI: 10.3748/wjg.v27.i34.5630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open

Wang N, Wang MP, Jiang L, Du B, Zhu B, Xi XM. Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study. BMC Anesthesiol 2021;21:220. [PMID: 34496742 PMCID: PMC8424878 DOI: 10.1186/s12871-021-01439-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open

Abstract

Background

Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The modified nutrition risk in the critically ill score (mNUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients, but it has not been fully demonstrated and widely used. Our study was conducted to identify the nutritional risk in ICU patients using the mNUTRIC score and explore the relationship between 28-day mortality and high mNUTRIC scores.

Methods

This study is a secondary analysis, the data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. We divided the study population into high nutritional risk (mNUTRIC score ≥ 5 points) and low nutritional risk (mNUTRIC score < 5 points) groups. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis, appropriate cut-off was identified by highest combined sensitivity and specificity using Youden’s index. The significance level was set at 5%.

Results

Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, high nutritional risk patients were older (P < 0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740–0.786). According to Youden’s index, we found a suitable cut-off > 4 for the mNUTRIC score to predict the 28-day mortality.

Conclusions

Patients admitted to the ICU were at high risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality. More large prospective studies are needed to demonstrate the validity of this score.

Trial registration

This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875). Registered on 14 December 2011.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-021-01439-x.

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Mohialdeen Gubari MI, Hosseinzadeh-Attar MJ, Hosseini M, Mohialdeen FA, Othman H, Hama-ghareeb KA, Norouzy A. Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review. Galen Med J 2021;9:e1678. [PMID: 34466565 PMCID: PMC8344180 DOI: 10.31661/gmj.v9i0.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022] Open

Kumar N, Kumar A, Kumar A, Pattanayak A, Singh K, Singh PK. NUTRIC score as a predictor of outcome in COVID-19 ARDS patients: A retrospective observational study. Indian J Anaesth 2021;65:669-675. [PMID: 34764502 PMCID: PMC8577713 DOI: 10.4103/ija.ija_474_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023] Open

Lin PY, Yen YT, Lam CT, Li KC, Lu MJ, Hsu HS. Use of modified-NUTRIC score to assess nutritional risk in surgical intensive care unit. J Chin Med Assoc 2021;84:860-864. [PMID: 34108425 DOI: 10.1097/jcma.0000000000000565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open

Abstract

BACKGROUND

Modified Nutrition Risk in the Critically Ill (m-NUTRIC) score is used to evaluate the nutritional risk of patients in intensive care units (ICUs). This study aimed to investigate whether m-NUTRIC can be used as a predictive factor related to the outcome of patients in surgical ICU (SICU) and to identify which patients will benefit from aggressive nutritional intervention according to the results of m-NUTRIC score.

METHODS

A total of 205 patients who were admitted to surgical ICU (SICU) with ventilator use for more than 24 hours were enrolled. The m-NUTRIC score data were calculated the day when the patients were admitted to SICU. Patients were divided into two groups according to their m-NUTRIC score: the low-risk group (<5 points, 116 patients) and the high risk group (≥5 points, 89 patients).

RESULTS

In this study, a total of 205 patients were enrolled for analysis, including patients in the low-risk group (n = 116) and those in the high risk group (n = 89). The mean duration of ventilator use was 3.6 ± 6.5 days, and average SICU stays for all patients was 5.1 ± 7.4 days. The SICU mortality was significantly higher in the high-risk group (10.3% vs 1.7%). Comparison between survivals and nonsurvivals was carried out, and the data showed that the AKI, Vasopressors, SOFA, APACHE-II, m-NUTRIC score, and shock patient were all significantly associated with higher mortality. The multivariate analysis revealed that acute kidney injury (OR = 13.16; 95% confidence intervals = 3.69-46.92; p < 0.0001) and m-NUTRIC score were independent factors of ICU mortality in these patients. A receiver operating characteristic curve was used to calculate the area under the curve, which was 0.801. The data indicated that high m-NUTRIC score were significantly associated with SICU mortality with the cutoff score > 4 (sensitivity = 90.5%, specificity = 62.3%, p < 0.001).

CONCLUSION

We found in this study that the high m-NUTRIC score is an independent factor of ICU mortality, and m-NUTRIC score can be used as an initial screening tool for nutritional assessment in patients admitted to surgical ICU. Further investigations to evaluate whether the aggressive nutritional intervention would be beneficial in the SICU patients with higher m-NUTRIC score is mandatory.

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Alfonso Ortiz L, Jiang X, Turgeon AF, Wibbenmeyer L, Pollack J, Mandell SP, Day AG, Heyland DK. Validation of the modified NUTrition Risk Score (mNUTRIC) in mechanically ventilated, severe burn patients: A prospective multinational cohort study. Burns 2021;47:1739-1747. [PMID: 34119373 DOI: 10.1016/j.burns.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/19/2023]

Chada RR, Chidrawar S, Goud BA, Maska A, Medanki R, Nagalla B. Association between nutrition delivery, modified Nutrition Risk in Critically Ill score, and 28-day mortality. Nutr Clin Pract 2021;36:1020-1033. [PMID: 33964049 DOI: 10.1002/ncp.10673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 01/03/2023] Open

Cattani A, Eckert IC, Brito JE, Tartari RF, Silva FM. Nutritional risk in critically ill patients: how it is assessed, its prevalence and prognostic value: a systematic review. Nutr Rev 2021;78:1052-1068. [PMID: 32529226 DOI: 10.1093/nutrit/nuaa031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open

Javid Z, Zadeh Honarvar NM, Khadem-Rezaiyan M, Heyland DK, Shadnoush M, Ardehali SH, Lashkami SK, Maleki V. Translation and adaptation of the modified NUTRIC score for critically ill patients. Clin Nutr ESPEN 2021;43:348-352. [PMID: 34024539 DOI: 10.1016/j.clnesp.2021.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/05/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]

Pearcy J, Agarwal E, Isenring E, Somani A, Wright C, Shankar B. Ward-based nutrition care practices and a snapshot of patient care: Results from nutritionDay in the ICU. Clin Nutr ESPEN 2020;41:340-345. [PMID: 33487287 DOI: 10.1016/j.clnesp.2020.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]

Majari K, Imani H, Hosseini S, Amirsavadkouhi A, Ardehali SH, Khalooeifard R. Comparison of Modified NUTRIC, NRS-2002, and MUST Scores in Iranian Critically Ill Patients Admitted to Intensive Care Units: A Prospective Cohort Study. JPEN J Parenter Enteral Nutr 2020;45:1504-1513. [PMID: 33073363 DOI: 10.1002/jpen.2031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 10/14/2020] [Indexed: 12/20/2022]

Zhang P, Bian Y, Tang Z, Wang F. Use of Nutrition Risk in Critically Ill (NUTRIC) Scoring System for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Neurological Patients: A Prospective Observational Study. JPEN J Parenter Enteral Nutr 2020;45:1032-1041. [PMID: 32729938 DOI: 10.1002/jpen.1977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/23/2020] [Accepted: 07/27/2020] [Indexed: 01/06/2023]

Luo Z, Ang MJY, Chan SY, Yi Z, Goh YY, Yan S, Tao J, Liu K, Li X, Zhang H, Huang W, Liu X. Combating the Coronavirus Pandemic: Early Detection, Medical Treatment, and a Concerted Effort by the Global Community. RESEARCH (WASHINGTON, D.C.) 2020;2020:6925296. [PMID: 32607499 PMCID: PMC7315394 DOI: 10.34133/2020/6925296] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]

Affiliation(s)

Zichao Luo Department of Chemistry, National University of Singapore, Singapore 117543, Singapore
Melgious Jin Yan Ang Department of Chemistry, National University of Singapore, Singapore 117543, Singapore NUS Graduate School for Integrative Sciences and Engineering, Singapore 117456, Singapore
Siew Yin Chan Frontiers Science Center for Flexible Electronics & Shaanxi Institute of Flexible Electronics, Northwestern Polytechnical University, Xi'an 710072, China
Zhigao Yi Department of Chemistry, National University of Singapore, Singapore 117543, Singapore
Yi Yiing Goh Department of Chemistry, National University of Singapore, Singapore 117543, Singapore NUS Graduate School for Integrative Sciences and Engineering, Singapore 117456, Singapore
Shuangqian Yan Department of Chemistry, National University of Singapore, Singapore 117543, Singapore
Jun Tao Sports Medical Centre, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, China
Kai Liu State Key Laboratory of Rare Earth Resource Utilization, Chang Chun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
Xiaosong Li Department of Oncology, The Fourth Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100048, China
Hongjie Zhang State Key Laboratory of Rare Earth Resource Utilization, Chang Chun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China Department of Chemistry, Tsinghua University, Beijing 100084, China
Wei Huang Frontiers Science Center for Flexible Electronics & Shaanxi Institute of Flexible Electronics, Northwestern Polytechnical University, Xi'an 710072, China Key Laboratory of Flexible Electronics & Institute of Advanced Materials, Nanjing Tech University, Nanjing 211816, China
Xiaogang Liu Department of Chemistry, National University of Singapore, Singapore 117543, Singapore The N.1 Institute for Health, National University of Singapore, Singapore Joint School of National University of Singapore and Tianjin University, International Campus of Tianjin University, Fuzhou 350807, China

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The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients. Clin Nutr 2020;40:534-541. [PMID: 32527576 PMCID: PMC7273137 DOI: 10.1016/j.clnu.2020.05.051] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]

Abstract

Background & aims

In the newly emerged Coronavirus Disease 2019 (COVID-19) disaster, little is known about the nutritional risks for critically ill patients. It is also unknown whether the modified Nutrition Risk in the Critically ill (mNUTRIC) score is applicable for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. We set out to investigate the applicability of the mNUTRIC score for assessing nutritional risks and predicting outcomes for these critically ill COVID-19 patients.

Methods

This retrospective observational study was conducted in three ICUs which had been specially established and equipped for COVID-19 in Wuhan, China. The study population was critically ill COVID-19 patients who had been admitted to these ICUs between January 28 and February 21, 2020. Exclusion criteria were as follows: 1) patients of ＜18 years; 2) patients who were pregnant; 3) length of ICU stay of ＜24 h; 4) insufficient medical information available. Patients' characteristics and clinical information were obtained from electronic medical and nursing records. The nutritional risk for each patient was assessed at their ICU admission using the mNUTRIC score. A score of ≥5 indicated high nutritional risk. Mortality was calculated according to patients’ outcomes following 28 days of hospitalization in ICU.

Results

A total of 136 critically ill COVID-19 patients with a median age of 69 years (IQR: 57–77), 86 (63%) males and 50 (37%) females, were included in the study. Based on the mNUTRIC score at ICU admission, a high nutritional risk (≥5 points) was observed in 61% of the critically ill COVID-19 patients, while a low nutritional risk (<5 points) was observed in 39%. The mortality of ICU 28-day was significantly higher in the high nutritional risk group than in the low nutritional risk group (87% vs 49%, P ＜0.001). Patients in the high nutritional risk group exhibited significantly higher incidences of acute respiratory distress syndrome, acute myocardial injury, secondary infection, shock and use of vasopressors. Additionally, use of a multivariate Cox analysis showed that patients with high nutritional risk had a higher probability of death at ICU 28-day than those with low nutritional risk (adjusted HR = 2.01, 95% CI: 1.22–3.32, P = 0.006).

Conclusions

A large proportion of critically ill COVID-19 patients had a high nutritional risk, as revealed by their mNUTRIC score. Patients with high nutritional risk at ICU admission exhibited significantly higher mortality of ICU 28-day, as well as twice the probability of death at ICU 28-day than those with low nutritional risk. Therefore, the mNUTRIC score may be an appropriate tool for nutritional risk assessment and prognosis prediction for critically ill COVID-19 patients.

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Alramly MK, Abdalrahim MS, Khalil A. Validation of the modified NUTRIC score on critically ill Jordanian patients: A retrospective study. Nutr Health 2020;26:225-229. [PMID: 32468911 DOI: 10.1177/0260106020923832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Rattanachaiwong S, Zribi B, Kagan I, Theilla M, Heching M, Singer P. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clin Nutr 2020;39:3419-3425. [PMID: 32199698 DOI: 10.1016/j.clnu.2020.02.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 11/26/2022]

Brascher J, Peres W, Padilha P. Use of the modified “Nutrition Risk in the critically ill” score and its association with the death of critically ill patients. Clin Nutr ESPEN 2020;35:162-166. [DOI: 10.1016/j.clnesp.2019.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/12/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022]

Ibrahim DA, Elkabarity RH, Moustafa ME, El-Gendy HA. Modified NUTRIC score and outcomes in critically ill patients: A meta-analysis. EGYPTIAN JOURNAL OF ANAESTHESIA 2020;36:288-296. [DOI: 10.1080/11101849.2020.1848240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 02/08/2023] Open

Kumar S, Gattani SC, Baheti AH, Dubey A. Comparison of the Performance of APACHE II, SOFA, and mNUTRIC Scoring Systems in Critically Ill Patients: A 2-year Cross-sectional Study. Indian J Crit Care Med 2020;24:1057-1061. [PMID: 33384511 PMCID: PMC7751038 DOI: 10.5005/jp-journals-10071-23549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open

Abstract

Aims and objectives

Different severity scores are being used to assess outcomes in intensive care unit, but variable data had been reported so far per their performance. Main objective of this study is to compare performance of acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and modified nutrition risk in critically ill (mNUTRIC) scoring systems regarding the outcomes in the form of morbidity and mortality in medical intensive care unit (MICU) at rural tertiary-care health center.

Materials and methods

In this cross-sectional study, 1,990 patients older than 18 years admitted in the ICU were enrolled. Age, gender, diagnosis, intubation, comorbidities, APACHE II, SOFA scores, m NUTRIC score, MICU stays in days, and need of mechanical ventilation were noted.

Results

When we compared different score with mortality, APACHE-II was having sensitivity of 89.9% and specificity of 97.6%; SOFA had 90.1% sensitivity and 96.6% specificity; while mNUTRIC score had 97.2% sensitivity and 74.0% specificity. APACHE-II score had sensitivity of 93.4%, SOFA had 90.5%, and mNUTRIC score 92.3% with low specificity of 76.5% in predicting requirement of mechanical ventilation. mNUTRIC score and ICU length of stay showed moderate positive correlation (p value = <0.001).

Conclusion

All the three scores were comparable in sensitivity and specificity in predicting outcomes in the form of mortality, need of mechanical ventilation, and length of ICU stays. mNUTRIC score was more sensitive than others, and as it was based on nutritional status, hence more weightage should be given on this score.

How to cite this article

Kumar S, Gattani SC, Baheti AH, Dubey A. Comparison of the Performance of APACHE II, SOFA, and mNUTRIC Scoring Systems in Critically Ill Patients: A 2-year Cross-sectional Study. Indian J Crit Care Med 2020;24(11):1057–1061.

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Al-Kalaldeh M, Suleiman K, Al-Kalaldeh O. Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence With the Bioelectrical Impedance Analysis. Nutr Clin Pract 2019;35:559-566. [PMID: 31713274 DOI: 10.1002/ncp.10440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open

Kenworthy S, Agarwal E, Farlow L, Angus R, Marshall AP. Feasibility of using the "modified NUTrition Risk In the Critically ill" nutritional risk screening tool to identify nutritionally at-risk patients in an Australian intensive care unit. Aust Crit Care 2019;33:259-263. [PMID: 31679984 DOI: 10.1016/j.aucc.2019.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

The modified NUTrition Risk In the Critically ill (mNUTRIC) score has been demonstrated to accurately quantify the risk of negative patient outcomes and discriminate which patients will benefit the most from nutrition intervention in an intensive care unit (ICU) setting. Calculation of an mNUTRIC score, however, may be time-intensive and unable to be performed within available resources. This may prevent high-risk patients from being identified and reviewed by a dietitian.

OBJECTIVES

The purpose of this study was to assess the feasibility of using the mNUTRIC tool to screen for patients at increased nutrition risk and to determine the proportion of those high-risk patients who were reviewed by a dietitian.

SUBJECTS/METHODS

A retrospective observational study of 260 critically ill patients was conducted between 01/01/2017 and 30/05/2017 in a 20-bed Australian tertiary ICU. Participants included all adults admitted to the ICU for more than 72 h. Feasible implementation was defined as calculating an mNUTRIC score in <5 min per patient where all data were available for >90% of patients.

RESULTS

A median time of 4 min and 54 s (interquartile range: 4.3-5.6 min) was required to calculate each mNUTRIC score, with 96% of scores calculated in <10 min. Data were available to calculate mNUTRIC scores for 93% (241/260) of patients. The mNUTRIC tool identified 81 patients at high nutrition risk, 44% (36/81) of whom were not reviewed by a dietitian. There were 21 high-risk patients who were purposefully excluded from dietetic review for various clinical reasons, leaving 15 high-risk patients (19%) who were not reviewed by a dietitian.

CONCLUSIONS

Implementation of the mNUTRIC tool was not feasible in our ICU, given the set dietetic resources (0.6 full-time equivalent). Shared responsibility of nutrition screening or automating the calculation may be possible solutions to increase feasibility of mNUTRIC screening.

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Reis AMD, Fructhenicht AVG, Moreira LF. NUTRIC score use around the world: a systematic review. Rev Bras Ter Intensiva 2019;31:379-385. [PMID: 31618358 PMCID: PMC7005961 DOI: 10.5935/0103-507x.20190061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022] Open

Yıldırım S, Orak Y, Menemencioğlu R, Altun A, Orak F, Düger C, Özpay E, Yazar FM. The use of empirical antibiotics in intensive care unit and relationship between nutrition and the incidence of infection. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.620514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open

Javid Mishamandani Z, Norouzy A, Hashemian SM, Khoundabi B, Rezaeisadrabadi M, Safarian M, Nematy M, Pournik O, Jamialahmadi T, Shadnoush M, Moghaddam OM, Zand F, Beigmohammadi MT, Khoshfetrat M, Shafiei E, Sedaghat A. Nutritional status of patients hospitalized in the intensive care unit: A comprehensive report from Iranian hospitals, 2018. J Crit Care 2019;54:151-158. [PMID: 31446233 DOI: 10.1016/j.jcrc.2019.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/08/2019] [Accepted: 08/01/2019] [Indexed: 12/15/2022]

Abstract

INTRODUCTION AND AIM

Malnutrition is a complication of hospitalization in critically ill patients. This event is occurred because of disease and therapeutic processes for curing the patients. Determination of nutritional status helps physicians and clinical nutritionists decide on the best regimen which should be prescribed for a patient. In the current study, we aimed to report the nutritional status ofpatientshospitalizedin the intensive care unit (ICU).

METHOD OF STUDY

We used three standard tolls, including Subjective global assessment (SGA), Nutrition Risk in the Critically Ill (NUTRIC) Score and nutrition risk screening (NRS) questionnaires via a multi-stage sampling for different ICU wards of 32 university hospitals in Iran. Frequencies and rates of nutritional scores, comparative studies, and determined agreement of scoring systems and nutritional status in any ward of hospitals were evaluated.

RESULTS

There were 771 males and 540 female Cancer and trauma patients had the best and worst nutritional scores, respectively. Using NRS and NUTRIC, the low-risk scores were more frequent than thehigh-riskscores among ICU patients. SGA showed that most patients were in grades A (well nutritional status) or B (moderate nutritional status), andfew caseswere in grade C (poor nutritional status).The high-risk nutritional score wasobtained for older patients. NUTRIC and NRS had better agreement for diagnosis and differentiation of malnutrition than NUTRIC-SGA or NRS-SGA pairs. However, there was no strong agreement between the mentioned pairs.

CONCLUSION

Nutritional status of patients hospitalized in ICU wards in Iran wassomewhat better than other countries that this could be due to the highly observed guidelines of patient's care in Iran. Anyway,it is suggested that a more precise tool of nutritional scoresto be validated for patients hospitalized in ICU·In addition, better medical care needs a well evaluation of nutritional insufficiencies and what is necessary for compensation using complementary regimens.

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Affiliation(s)

Zeinab Javid Mishamandani Student Research Committee, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abdolreza Norouzy Nutrition Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Seyed Mohammadreza Hashemian Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Batoul Khoundabi Iran Helal Institute of Applied-Science and Technology (Red Crescent Society of Iran), Tehran, Iran
Mohammad Rezaeisadrabadi Internal Medicine Department, Student Research Committee, Shahid Beheshti University of Medical sciences, Tehran, Iran
Mohammad Safarian Biochemistry and Nutrition Department, Mashhad University of Medical Science, Mashhad, Iran
Mohsen Nematy Biochemistry and Nutrition Department, Mashhad University of Medical Science, Mashhad, Iran
Omid Pournik Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
Tannaz Jamialahmadi Student Research Committee, Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mahdi Shadnoush Semnan University of Medical Sciences, Semnan, Iran; Department of Clinical Nutrition, Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Omid Moradi Moghaddam Trauma and Injury Research Center, Critical Care Department, Rasoul-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, Iran
Farid Zand Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Mohammad Taghi Beigmohammadi Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Masoum Khoshfetrat Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
Elham Shafiei Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Alireza Sedaghat Faculty of Critical Care Medicine, Lung Disease Research Center, Mashhad university of Medical Sciences, Mashhad, Iran

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Cadena AJ, Habib S, Rincon F, Dobak S. The Benefits of Parenteral Nutrition (PN) Versus Enteral Nutrition (EN) Among Adult Critically Ill Patients: What is the Evidence? A Literature Review. J Intensive Care Med 2019;35:615-626. [PMID: 31030601 DOI: 10.1177/0885066619843782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]

Brierley-Hobson S, Clarke G, O’Keeffe V. Safety and efficacy of volume-based feeding in critically ill, mechanically ventilated adults using the 'Protein & Energy Requirements Fed for Every Critically ill patient every Time' (PERFECT) protocol: a before-and-after study. Crit Care 2019;23:105. [PMID: 30940173 PMCID: PMC6444687 DOI: 10.1186/s13054-019-2388-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/07/2019] [Indexed: 12/22/2022] Open

Abstract

BACKGROUND

Underfeeding in critical illness is common and associated with poor outcomes. According to large prospective hospital studies, volume-based feeding (VBF) safely and effectively improves energy and protein delivery to critically ill patients compared to traditional rate-based feeding (RBF) and might improve patient outcomes. A before-and-after study was designed to evaluate the safety, efficacy and clinical outcomes associated with VBF compared to RBF in a single intensive care unit (ICU).

METHODS

The sample included consecutively admitted critically ill adults, mechanically ventilated for at least 72 h and fed enterally for a minimum of 48 h. The first cohort (n = 46) was fed using RBF, the second (n = 46) using VBF, and observed for 7 days, or until extubation or death. Statistical comparison of percentage feed volume, energy and protein delivered, plus indices of feed intolerance, were the primary outcomes of interest. Secondary observations included ventilation period, mortality, and length of ICU stay (LOICUS).

RESULTS

Groups were comparable in baseline clinical and demographic characteristics and nutrition practices. Volume delivered to the VBF group increased significantly by 11.2% (p ≤ 0.001), energy by 13.4% (p ≤ 0.001) and protein by 8.4% (p = 0.02), compared to the RBF group. In the VBF group, patients meeting > 90% of energy requirements increased significantly from 47.8 to 84.8% (p ≤ 0.001); those meeting > 90% of protein requirements changed from 56.5 to 73.9% (p = 0.134). VBF did not increase symptoms of feed intolerance. Adjusted binomial logistic regression found each additional 1% of prescribed feed delivered decreased the odds of vomiting by 0.942 (5.8%), 95% CI [0.900-0.985], p = 0.010. No differences in mortality or LOICUS were identified. Kaplan-Meier found a significantly increased extubation rate in patients receiving > 90% of protein requirements compared to those meeting < 80%, (p = 0.006). Adjusted Cox regression found the daily probability of being extubated tripled in patients receiving > 90% of their protein needs compared to the group receiving < 80%, hazard ratio 3.473, p = 0.021, 95% CI [1.205-10.014].

CONCLUSION

VBF safely and effectively increased the delivery of energy and protein to critically ill patients. Increased protein delivery may improve extubation rate which has positive patient-centred and financial implications, warranting larger confirmatory trials. This investigation adds weight to the ICU literature supporting VBF, and the growing evidence which advocates for enhanced protein delivery to improve patient outcomes.

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Chourdakis M, Grammatikopoulou MG, Poulia KA, Passakiotou M, Pafili ZK, Bouras E, Doundoulakis I, Galitsianos I, Lappa T, Karakatsanis A, Heyland DK. Translation of the modified NUTRIC score and adaptation to the Greek ICU setting. Clin Nutr ESPEN 2019;29:72-76. [DOI: 10.1016/j.clnesp.2018.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]