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VOLUME 28 , ISSUE 5 ( May, 2024 ) > List of Articles

SYSTEMATIC REVIEW

Modified NUTRIC Score as a Predictor of All-cause Mortality in Critically Ill Patients: A Systematic Review and Meta-analysis

Jay Prakash, Saket Verma, Priyanka Shrivastava, Khushboo Saran, Archana Kumari, Kunal Raj, Amit Kumar, Hemant N Ray, Pradip K Bhattacharya

Keywords : Critically ill patients, Meta-analysis, Modified NUTRIC score, Mortality prediction, Systematic review

Citation Information : 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 (5):495-503.

DOI: 10.5005/jp-journals-10071-24706

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Purpose: The purpose of our meta-analysis was to look at the impact of modified nutrition risk in the critically ill (mNUTRIC) on mortality in patients with critical illness. Materials and methods: Literature relevant to this meta-analysis was searched in PubMed, Web of Science, and Cochrane Library till 26 August 2023. Prospective or retrospective studies, patients >18 years of age, studies that reported on mortality and mNUTRIC (mNUTRIC cut-off score) were included. The QUIPS tool was used to evaluate the risk for bias in prognostic factors. Results: A total of 31 studies on mNUTRIC score, involving 13,271 patients were included. The summary area under the curve (sAUC) of 0.80 (95% CI: 0.76–0.83) illustrates the mNUTRIC score's strong discrimination. The pooled sensitivity was 0.79 (95% CI: 0.74–0.84) and pooled specificity was 0.68 (95% CI: 0.63–0.73). We found no discernible variation in the mNUTRIC's prediction accuracy among cut-off values of <5 and >5 in our subgroup analysis and sAUC values were 0.82 (95% CI: 0.78–0.85) and 0.78 (95% CI: 0.74–0.81), respectively. Conclusion: We observed that mNUTRIC can discriminate between critically ill individuals and predict their mortality.


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  1. Kirkland LL, Kashiwagi DT, Brantley S, Scheurer D, Varkey P. Nutrition in the hospitalized patient. J Hosp Med 2013;8(1):52–58. DOI: 10.1002/jhm.1969.
  2. Sheean PM, Peterson SJ, Gurka DP, Braunschweig CA. Nutrition assessment: The reproducibility of subjective global assessment in patients requiring mechanical ventilation. Eur J Clin Nutr 2010;64(11):1358–1364. DOI: 10.1038/ejcn.2010.154.
  3. Mendes R, Policarpo S, Fortuna P, Alves M, Virella D, Heyland DK; Portuguese NUTRIC Study Group. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients–A multicenter prospective cohort study. J Crit Care 2013;37(6):45–49. DOI: 10.1016/j.jcrc.2016.08.001.
  4. Hamilton C, Boyce VJ. Addressing malnutrition in hospitalized adults. JPEN J Parenter Enteral Nutr 2013;37(6):808–815. DOI: 10.1177/0148607113497224.
  5. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: An interdisciplinary call to action to address adult hospital malnutrition. JPEN J Parenter Enteral Nutr 2013;37(4):482–497. DOI: 10.1177/0148607113484066.
  6. van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014;33(1):39–58. DOI: 10.1016/j.clnu.2013.04.008.
  7. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: The development and initial validation of a novel risk assessment tool. Crit Care 2011;15(6):R268. DOI: 10.1186/cc10546.
  8. Liberti A, Piacentino E, Umbrello M, Muttini S. Comparison between Nutric Score and modified nutric score to assess ICU mortality in critically ill patients with COVID-19. Clin Nutr ESPEN 2021;44:479–482. DOI: 10.1016/j.clnesp.2021.04.026.
  9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: 10.1136/bmj.n71.
  10. Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med 2013;158(4):280–286. DOI: 10.7326/0003-4819-158-4-201302190-00009.
  11. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21(11):1539–1558. DOI: 10.1002/sim.1186.
  12. https://handbook-5-1.cochrane.org/chapter_7/7_7_3_5_mediansand_interquartile_ranges.
  13. Mukhopadhyay A, Henry J, Ong V, Leong CS, Teh AL, van Dam RM, et al. Association of modified NUTRIC score with 28-day mortality in critically ill patients. Clin Nutr 2017;36(4):1143–1148. DOI: 10.1016/j.clnu.2016.08.004.
  14. Gulsoy KY, Orhan S. The relationship between mortality and the modified nutrition risk in critically Ill (mNUTRIC) and nutritional risk screening 2002 (NRS-2002) scores in the intensive care unit. J Coll Physicians Surg Pak 2022;32(7):848–854. DOI: 10.29271/jcpsp.2022.07.848.
  15. Im KM, Kim EY. Identification of ICU patients with high nutritional risk after abdominal surgery using modified NUTRIC score and the association of energy adequacy with 90-day mortality. Nutrients 2022;14(5):946. DOI: 10.3390/nu14050946.
  16. Jeong DH, Hong SB, Lim CM, Koh Y, Seo J, Kim Y, et al. Comparison of accuracy of NUTRIC and modified NUTRIC scores in predicting 28-day mortality in patients with sepsis: A single center retrospective study. Nutrients 2018;10(7):911. DOI: 10.3390/nu10070911.
  17. 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(1):220. DOI: 10.1186/s12871-021-01439-x.
  18. Kim SJ, Lee HY, Choi SM, Lee SM, Lee J. Comparison of mNUTRIC-S2 and mNUTRIC scores to assess nutritional risk and predict intensive care unit mortality. Acute Crit Care 2022;37(4):618–626. DOI: 10.4266/acc.2022.00612.
  19. 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. J Assoc Physicians India 2022;70(11):11–12. DOI: 10.5005/japi-11001-0132.
  20. Tsai MH, Huang HC, Peng YS, Chen YC, Tian YC, Yang CW, et al. Nutrition risk assessment using the modified NUTRIC score in cirrhotic patients with acute gastroesophageal variceal bleeding: Prevalence of high nutrition risk and its independent prognostic value. Nutrients 2019;11(9):2152. DOI: 10.3390/nu11092152.
  21. 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(9):860–864. DOI: 10.1097/JCMA.000000000 0000565.
  22. Tseng CC, Tu CY, Chen CH, Wang YT, Chen WC, Fu PK, et al. Significance of the modified NUTRIC score for predicting clinical outcomes in patients with severe community-acquired pneumonia. Nutrients 2021;14(1):198. DOI: 10.3390/nu14010198.
  23. Alramly MK, Abdalrahim MS, Khalil A. Validation of the modified NUTRIC score on critically ill Jordanian patients: A retrospective study. Nutr Health 2020;26(3):225–229. DOI: 10.1177/0260106020923832.
  24. Acehan S, Gulen M, Isıkber C, Unlu N, Sumbul HE, Gulumsek E, et al. mNUTRIC tool is capable to predict nutritional needs and mortality early in patients suffering from severe pneumonia. Clin Nutr ESPEN 2021;45:184–191. DOI: 10.1016/j.clnesp.2021.08.030.
  25. Zheng C, Xie K, Li XK, Wang GM, Luo J, Zhang C, et al. The prognostic value of modified NUTRIC score for patients in cardiothoracic surgery recovery unit: A retrospective cohort study. J Hum Nutr Diet 2021;34(6):926–934. DOI: 10.1111/jhn.12899.
  26. Mayr U, Pfau J, Lukas M, Bauer U, Herner A, Rasch S, et al. NUTRIC and modified NUTRIC are accurate predictors of outcome in End-Stage Liver Disease: A validation in critically Ill patients with Liver cirrhosis. Nutrients 2020;12(7):2134. DOI: 10.3390/nu12072134.
  27. de Vries MC, Koekkoek WK, Opdam MH, van Blokland D, van Zanten AR. Nutritional assessment of critically ill patients: Validation of the modified NUTRIC score. Eur J Clin Nutr 2018;72(3):428–435. DOI: 10.1038/s41430-017-0008-7.
  28. Chen D, Zhao B, Wang L, Qiu Y, Mao E, Sheng H, et al. Prognostic performance of the NRS2002, NUTRIC, and modified NUTRIC to identify high nutritional risk in severe acute pancreatitis patients. Front Nutr 2023;10:1101555. DOI: 10.3389/fnut.2023.1101555.
  29. Ata Ur-Rehman HM, Ishtiaq W, Yousaf M, Bano S, Mujahid AM, Akhtar A. Modified nutrition risk in critically Ill (mNUTRIC) score to assess nutritional risk in mechanically ventilated patients: A prospective observational study from the Pakistani population. Cureus 2018;10(12):e3786. DOI: 10.7759/cureus.3786.
  30. Hai PD, Viet Hoa LT. The prognostic accuracy evaluation of mNUTRIC, APACHE II, SOFA, and SAPS 2 scores for mortality prediction in patients with sepsis. Crit Care Res Pract 2022;2022:4666594. DOI: 10.1155/2022/4666594.
  31. Mahmoodpoor A, Sanaie S, Sarfaraz T, Shadvar K, Fattahi V, Hamishekar H, et al. 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(1):131. DOI: 10.1186/s12871-023-02086-0.
  32. Todur P, Nileshwar A, Chaudhuri S, Maddani SS, Rao S, Thejesh S. Utility of the modified nutritional risk in the critically ill score as an outcome predictor in all-cause acute respiratory distress syndrome and acute febrile illness-induced acute respiratory distress syndrome. J Emerg Trauma Shock 2022;15(4):173–179. DOI: 10.4103/jets.jets_98_22.
  33. Zhang RX, Zhang WW, Luo YT, Liu GW. An mNUTRIC-based nomogram for predicting the in-hospital death risk in patients with acute stroke. Eur J Clin Nutr 2022;76(10):1464–1469. DOI: 10.1038/s41430-022-01127-0.
  34. Wang N, Wang P, Li W, Jiang L, Wang M, Zhu B, et al. Prognostic significance of malnutrition risk in elderly patients with acute kidney injury in the intensive care unit. BMC Nephrol 2022;23(1):335. DOI: 10.1186/s12882-022-02949-7.
  35. Acehan S, Gulen M, Satar S, Kuvvetli A, Isikber C, Yesiloglu O, et al. Evaluation of nutrition risk in patients over 65 years of age with nontraumatic acute abdominal syndrome. Nutr Clin Pract 2020;35(6):1070–1079. DOI: 10.1002/ncp.10575.
  36. 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(5):253–256. DOI: 10.4103/ijccm.IJCCM_24_17.
  37. Ma Z, Zhang Y, Zhang Q, Wu B. Modified nutrition risk in critically ill is an effective nutrition risk screening tool in severely burned patients, compared with nutrition risk screening 2002. Front Nutr 2022;9:1007885. DOI: 10.3389/fnut.2022.1007885.
  38. 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. DOI: 10.5005/jp-journals-10071-23549.
  39. Kucuk B, Baltaci Ozen S, Kocabeyoglu GM, Mutlu NM, Cakir E, Ozkocak Turan I. NUTRIC score is not superior to mNUTRIC score in prediction of mortality of COVID-19 patients. Int J Clin Pract 2022;2022:1864776. DOI: 10.1155/2022/1864776.
  40. Leoni MLG, Moschini E, Beretta M, Zanello M, Nolli M. The modified NUTRIC score (mNUTRIC) is associated with increased 28-day mortality in critically ill COVID-19 patients: Internal validation of a prediction model. Clin Nutr ESPEN 2022;48:202–209. DOI: 10.1016/j.clnesp.2022.02.014.
  41. 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(7):1648. DOI: 10.3390/nu15071648.
  42. Brascher JMM, Peres WAF, Padilha PC. 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.
  43. Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr 2016;35(1):158–162. DOI: 10.1016/j.clnu.2015.01.015.
  44. Ozbilgin S, Hanci V, Omur D, Özbilgin M, Tosun M, Yurtlu S, et al. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine (Baltimore) 2016;95(40):e5038. DOI: 10.1097/MD.0000000000005038.
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