title: Association of modified NUTRIC score with 28-day mortality in critically ill patients.
abstract: For patients in the intensive care unit (ICU), nutritional risk assessment is often difficult. Traditional scoring systems cannot be used for patients who are sedated or unconscious since they are unable to provide information on their history of food intake and weight loss. We aim to validate the NUTRIC (NUTrition RIsk in Critically ill) score, an ICU-specific nutrition risk assessment tool in Asian patients.
  
  
  
  This was an observational study in the medical ICU of a university-affiliated tertiary hospital. We included all adult patients (≥18years) admitted between October 2013 and September 2014 who stayed for more than 24 hours in the ICU. Components of the modified NUTRIC (mNUTRIC) score, demographic details, body mass index (BMI), use of mechanical ventilation (MV), vasopressor drugs, and renal replacement therapy (RRT) were obtained from the ICU database. For patients on MV (maximum 12 days), we calculated the energy intake and nutritional adequacy (energy received ÷ energy recommended) from enteral or parenteral feeding data. Multivariable logistic regression analysis was used with 28-day mortality as the outcome of interest.
  
  
  
  401 patients (62% male, mean age 60.0 ± 16.3 years, mean BMI 23.9 ± 6.2 kg/m2) were included. In the univariate analysis, BMI, mNUTRIC score, MV, vasopressor drug, and RRT were associated with 28-day mortality. In the multivariable logistic regression analysis, mNUTRIC score (Odds ratio, OR 1.48, Confidence Interval, CI 1.25-1.74, p < 0.001), vasopressor drug (OR 2.31, CI 1.28-4.15, p = 0.005), and BMI (OR 0.92, CI 0.87-0.97, p = 0.002) were associated with 28-day mortality. Nutritional adequacy was assessed in a subgroup of 273 (68%) patients who received MV for at least 48 hours. Median (IQR) nutritional adequacy was 0.44 (0.15-0.70). In patients with high mNUTRIC score (5-9), higher nutritional adequacy was associated with a lower predicted 28-day mortality; this was not observed in patients with low mNUTRIC (0-4) score (effect modification, p interaction <0.001).
  
  
  
  In a mixed Asian ICU population, mNUTRIC score is independently associated with 28-day mortality. Increased nutritional adequacy may reduce the 28-day mortality in patients with a high mNUTRIC score.
authors: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System and National University of Singapore, Singapore. Electronic address: amartya.mukherjee@gmail.com.
authors: Amartya
authors: A
authors: Mukhopadhyay
authors: Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore.
authors: Jeyakumar
authors: J
authors: Henry
authors: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System and National University of Singapore, Singapore.
authors: Venetia
authors: V
authors: Ong
authors: Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Singapore.
authors: Claudia Shu-Fen
authors: CS
authors: Leong
authors: Singapore Institute for Clinical Sciences, Singapore.
authors: Ai Ling
authors: AL
authors: Teh
authors: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
authors: Rob M
authors: RM
authors: van Dam
authors: Alice Lee Centre for Nursing Studies, National University Health System and National University of Singapore, Singapore.
authors: Yanika
authors: Y
authors: Kowitlawakul
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009026:Mortality; D015596:Nutrition Assessment; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011446:Prospective Studies; D012306:Risk; D012846:Singapore / Q000453:epidemiology; D062606:Tertiary Care Centers
keywords: Intensive care unit; Mortality; Nutrition; Nutritional adequacy