Posgraduate Program in Food, Nutrition, and Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
JPEN J Parenter Enteral Nutr. 2020 Sep;44(7):1250-1256. doi: 10.1002/jpen.1804. Epub 2020 Feb 6.
Identification of nutritional risk in critically ill patients is a challenge because each nutritional screening tool has its specific characteristics. The objective was to evaluate the performance of the modified Nutrition Risk in Critically ill (mNUTRIC) score, used alone or in combination with the Nutritional Risk Screening 2002 (NRS-2002) score, to predict hospital mortality in critically ill patients.
A prospective study was performed with patients admitted to the intensive care unit (ICU) from October 2017 to April 2018. Multiple logistic regression analysis was used to test for complementarity between the mNUTRIC and NRS-2002. A receiver operating characteristic (ROC) curve was used to identify the performance of the instruments to predict mortality. This study was conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement.
384 patients were evaluated (51.8% female mean age 59.6 ± 16.7 years). High nutritional risk was detected in 54.4% by the NRS-2002 and 48.4% by mNUTRIC. The overall mortality rate was 36.5% (n = 140). Patients in whom nutritional risk was identified both by mNUTRIC and by NRS-2002 (score ≥5) had a twofold greater risk of in-hospital mortality (RR = 2.29; 95%CI: 1.42-3.68; p = 0.001). The area under the ROC curve to predict mortality was 0.693 for mNUTRIC; 0.645 for NRS-2002; and 0.666 for mNUTRIC and NRS-2002 combined.
The mNUTRIC and NRS-2002 scores had similar performance in predicting hospital mortality. The mNUTRIC has better discriminant ability to quantify the risk of mortality in critically ill patients.
识别危重症患者的营养风险是一项挑战，因为每种营养筛查工具都有其特定的特点。本研究旨在评估改良的危重症患者营养风险评分（mNUTRIC）单独或与营养风险筛查 2002（NRS-2002）评分联合使用，预测危重症患者住院死亡率的表现。
这是一项前瞻性研究，纳入 2017 年 10 月至 2018 年 4 月入住重症监护病房（ICU）的患者。采用多因素逻辑回归分析测试 mNUTRIC 和 NRS-2002 之间的互补性。采用受试者工作特征（ROC）曲线来确定这些工具预测死亡率的性能。本研究遵循了加强观察性研究报告的流行病学（STROBE）声明。
共评估了 384 例患者（51.8%为女性，平均年龄为 59.6±16.7 岁）。NRS-2002 检测到高营养风险的患者占 54.4%，mNUTRIC 占 48.4%。总的死亡率为 36.5%（n=140）。mNUTRIC 和 NRS-2002 均检测到营养风险（评分≥5）的患者住院死亡率增加了两倍（RR=2.29；95%CI：1.42-3.68；p=0.001）。预测死亡率的 ROC 曲线下面积 mNUTRIC 为 0.693，NRS-2002 为 0.645，mNUTRIC 和 NRS-2002 联合为 0.666。
mNUTRIC 和 NRS-2002 评分在预测住院死亡率方面表现相似。mNUTRIC 具有更好的鉴别能力，可以量化危重症患者的死亡风险。
