title: Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool.
abstract: BACKGROUND
  To develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU).
  
  
  METHODS
  A prospective, observational study of patients expected to stay > 24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) < 20, estimated % oral intake in the week prior, weight loss in the last 3 months and serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels. Approximate quintiles of each variable were assigned points based on the strength of their association with 28 day mortality.
  
  
  RESULTS
  A total of 597 patients were enrolled in this study. Based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI, CRP, PCT, estimated percentage oral intake and weight loss. As the score increased, so did mortality rate and duration of mechanical ventilation. Logistic regression demonstrated that nutritional adequacy modifies the association between the score and 28 day mortality (p = 0.01).
  
  
  CONCLUSIONS
  This scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy.
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada. dkh2@queensu.ca
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Xuran
authors.initials: X
authors.lastname: Jiang
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
mesh_terms: D018806:APACHE; D000368:Aged; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016009:Chi-Square Distribution; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004435:Eating; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D044623:Nutrition Therapy / Q000706:statistics & numerical data; D009752:Nutritional Status; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015431:Weight Loss
chemical_list: C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
references.citation: Mayo Clin Proc. 1988 Nov;63(11):1106-15
references.pmid: 3193819
references.citation: Clin Nutr. 2000 Apr;19(2):101-7
references.pmid: 10867727
references.citation: Nutr Clin Pract. 2008 Aug-Sep;23(4):373-82
references.pmid: 18682588
references.citation: Crit Care Med. 2011 Dec;39(12):2691-9
references.pmid: 21765355
references.citation: Clin Nutr. 2005 Feb;24(1):75-82
references.pmid: 15681104
references.citation: Nutrition. 1999 Jun;15(6):458-64
references.pmid: 10378201
references.citation: Crit Care Med. 1985 Oct;13(10):818-29
references.pmid: 3928249
references.citation: JPEN J Parenter Enteral Nutr. 2010 Mar-Apr;34(2):156-9
references.pmid: 20375423
references.citation: Nurs Times. 2003 Nov 18-24;99(46):26-7
references.pmid: 14666817
references.citation: JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):277-316
references.pmid: 19398613
references.citation: Crit Care. 2010;14(2):R78
references.pmid: 20429886
references.citation: Nutr Hosp. 2008 Jul-Aug;23(4):400-7
references.pmid: 18702178
references.citation: Intensive Care Med. 2009 Oct;35(10):1728-37
references.pmid: 19572118
references.citation: Crit Care Clin. 2010 Jul;26(3):433-41, vii
references.pmid: 20643297
references.citation: Clin Nutr. 2003 Aug;22(4):415-21
references.pmid: 12880610
references.citation: Clin Nutr. 2003 Jun;22(3):321-36
references.pmid: 12765673
references.citation: Clin Nutr. 2010 Oct;29(5):552-9
references.pmid: 20434820
references.citation: Intensive Care Med. 1999 Jul;25(7):686-96
references.pmid: 10470572
references.citation: Asia Pac J Clin Nutr. 2009;18(3):395-403
references.pmid: 19786388