Nutrition Department, Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Nutrition Department and Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
JPEN J Parenter Enteral Nutr. 2024 Jan;48(1):82-92. doi: 10.1002/jpen.2569. Epub 2023 Nov 7.
For patients who are critically ill, the recommended nutrition risk screening tools are the Nutrition Risk in the Critically Ill (NUTRIC) and the Nutritional Risk Screening 2002 (NRS-2002) have limitations.
To develop a new screening tool, the Screening of Nutritional Risk in Intensive Care (SCREENIC score), and assess its predictive validity.
A secondary analysis of a prospective cohort study was conducted. Variables from several nutritional screening and assessment tools were considered. The high nutrition risk cutoff point was defined using mNUTRIC as a reference. Predictive validity was evaluated using logistic regression and Cox regression.
The study included 450 patients (64 [54-71] years, 52.2% men). The SCREENIC score comprised six questions: (1) does the patient have ≥2 comorbidities (1.3 points); (2) was the patient hospitalized for ≥2 days before intensive care unit (ICU) admission (0.9 points); (3) does the patient have sepsis (1.0 point); (4) was the patient on mechanical ventilation upon ICU admission (1.2 points); (5) is the patient aged >65 years (1.2 points); and (6) does the patient exhibit signs of moderate/severe muscle mass loss according to the physical exam (0.6 points). The high nutrition risk cutoff point was set at 4.0. SCREENIC demonstrated moderate agreement (κ = 0.564) and high accuracy (0.896 [95% CI, 0.867-0.925]) with mNUTRIC. It predicted prolonged ICU (odds ratio [OR] = 1.81 [95% CI, 1.14-2.85]) and hospital stay (OR = 2.15 [95% CI, 1.37-3.38]).
The SCREENIC score comprises questions with variables that do not require nutrition history. Further evaluation of its applicability, reproducibility, and validity in guiding nutrition therapy is needed using large external cohorts.
对于危重症患者，推荐的营养风险筛查工具是营养风险指数（NUTRIC）和营养风险筛查 2002（NRS-2002）。但这两种工具都存在局限性。
开发一种新的筛查工具，即重症监护营养风险筛查（SCREENIC 评分），并评估其预测准确性。
对一项前瞻性队列研究进行二次分析。考虑了几种营养筛查和评估工具的变量。高营养风险截断点定义为 mNUTRIC 作为参考。使用逻辑回归和 Cox 回归评估预测准确性。
本研究纳入 450 例患者（64 [54-71] 岁，52.2%为男性）。SCREENIC 评分由 6 个问题组成：（1）患者是否合并≥2 种疾病（1.3 分）；（2）患者在 ICU 入院前住院≥2 天（0.9 分）；（3）患者是否患有脓毒症（1.0 分）；（4）患者 ICU 入院时是否接受机械通气（1.2 分）；（5）患者年龄>65 岁（1.2 分）；（6）根据体格检查患者是否有中等/重度肌肉量减少的迹象（0.6 分）。高营养风险截断点设定为 4.0。SCREENIC 与 mNUTRIC 具有中等一致性（κ=0.564）和高准确性（0.896 [95%CI，0.867-0.925]）。它预测 ICU 住院时间延长（优势比 [OR] = 1.81 [95%CI，1.14-2.85]）和住院时间延长（OR = 2.15 [95%CI，1.37-3.38]）。
SCREENIC 评分由不需要营养史的变量组成。需要使用大型外部队列进一步评估其在指导营养治疗中的适用性、可重复性和有效性。
