Use of nutrition risk in critically ill (NUTRIC) score to assess nutritional risk in mechanically ventilated patients: A prospective observational study

Nutritional support is an essential component of patient care in critically ill patients. 3] Malnutrition in critically ill patients is associated with an increased occurrence of nosocomial infections, prolonged hospitalization, and higher mortality. Acutely ill patients are under stress, this initiates a variety of metabolic responses such as stress hyperglycemia and skeletal muscle wasting, these patients need to be started on early nutritional support to attenuate the metabolic response to stress and prevent oxidative cellular injury. tritional assessment is the cornerstone in identifying patients at risk of malnutrition and it has to be done within 48 h of hospital admission. Nutritional screening in ICU patients is challenging because many of the parameters such as accurate history of dietary intake and weight loss may be difficult to obtain, as most of the patients are on mechanical ventilation and sedation. Changes in weight can be influenced by the edema due to underlying disease and large Context: Nutritional risk assessment must be done on all critically ill patients. Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. Traditional scoring systems cannot be used for screening in mechanically ventilated (MV) patients because these patients are unable to provide information on their history of food intake and weight loss. The Nutrition Risk in Critically ill (NUTRIC) score is the appropriate nutritional assessment tool in MV patients. Aims: This prospective observational study was conducted to identify the nutritional risk in MV patients using modified NUTRIC (mNUTRIC) score (with the exception of interleukin-6). Patients and Methods: All adult patients admitted to the ICU and required MV for more than 48 h were included in the study. Data were collected on variables required to calculate mNUTRIC score. Patients with mNUTRIC score 5 are considered at nutritional risk. Outcome data were collected on ICU length of stay, ventilator-free days, and mortality. Results: A total of 678 MV patients fit into the inclusion criteria. Majority of the patients were male (67%). Mean age of the patients was 55 years. About 288 (42.5%) patients were at high nutritional risk (mNUTRIC score 5). Patients with high mNUTRIC score 5 had longer mean ICU average length of stay of 9.0 (4.2) versus 7.8 (5.8) mean ( standard deviation) days (P < 0.01) and higher mortality 41.4% versus 26.1% (P < 0.0) compared to patients with low NUTRIC score (4). High mNUTRIC score (5) predicted mortality with area under the curve of 0.582 (95% confidence interval 0.535-0.628). Conclusions: Nearly 42.5% of MV patients admitted to ICU were at nutritional risk, and high mNUTRIC score was associated with increased ICU length of stay and higher mortality.