Yildirim Mehmet, Halacli Burcin, Kaya Esat Kivanc, Ulusoydan Ege, Ortac Ersoy Ebru, Topeli Arzu
Department of Internal Medicine, Division of Intensive Care, Faculty of Medicine, Hacettepe University, 06080 Ankara, Türkiye.
Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06080 Ankara, Türkiye.
J Clin Med. 2025 May 13;14(10):3382. doi: 10.3390/jcm14103382.
: Critically ill COVID-19 patients are at high risk of malnutrition; however, no study has directly compared the prognostic accuracy of different nutritional assessment tools. This study aimed to determine the optimal cutoff values for the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score, Nutritional Risk Screening 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST) and to evaluate their predictive value for ICU mortality. : A retrospective analysis was conducted on patients with laboratory-confirmed COVID-19 admitted to our ICU between 20 March 2020 and 15 June 2021. Clinical and laboratory data, as well as patient outcomes, were retrieved from electronic medical records and patient charts. The mNUTRIC, NRS 2002, and MUST scores were calculated at ICU admission. : The study included 397 patients, with 273 survivors and 124 non-survivors. The median age was 65 (55-76) years, and the median BMI was 26.1 (24.0-29.4). Non-survivors had significantly higher median scores in all three nutritional assessment tools compared to survivors (mNUTRIC: 5 vs. 3, NRS 2002: 4 vs. 3, MUST: 2 vs. 2; < 0.01). At the optimal cutoff values, mNUTRIC ≥ 4 demonstrated the highest prognostic accuracy (sensitivity: 0.77, specificity: 0.74; AUC = 0.75, CI = 0.70-0.81), followed by NRS 2002 ≥ 4 (sensitivity: 0.63, specificity: 0.60; AUC = 0.62, CI = 0.56-0.67) and MUST ≥ 3 (sensitivity: 0.21, specificity: 0.91; AUC = 0.56, CI = 0.50-0.68). Higher scores were associated with increased disease severity, poorer patient performance, prolonged hospital stays, and elevated ICU, 28-day, and overall hospital mortality rates. Among the three assessment tools, only an mNUTRIC score of ≥ 4 was independently associated with ICU mortality (OR = 1.54, CI = 1.21-1.96, < 0.01). : At ICU admission, mNUTRIC ≥ 4, NRS 2002 ≥ 4, and MUST ≥ 3 were identified as the most accurate predictors of mortality in critically ill COVID-19 patients. However, only the mNUTRIC score was an independent predictor of ICU mortality.
危重症 COVID-19 患者存在高营养不良风险；然而，尚无研究直接比较不同营养评估工具的预后准确性。本研究旨在确定危重症患者改良营养风险（mNUTRIC）评分、营养风险筛查 2002（NRS 2002）及营养不良通用筛查工具（MUST）的最佳临界值，并评估它们对重症监护病房（ICU）死亡率的预测价值。
对 2020 年 3 月 20 日至 2021 年 6 月 15 日期间入住我院 ICU 的实验室确诊 COVID-19 患者进行回顾性分析。从电子病历和患者病历中获取临床和实验室数据以及患者结局。在 ICU 入院时计算 mNUTRIC、NRS 2002 和 MUST 评分。
本研究纳入 397 例患者，其中 273 例存活，124 例未存活。中位年龄为 65（55 - 76）岁，中位体重指数（BMI）为 26.1（24.0 - 29.4）。与存活者相比，未存活者在所有三种营养评估工具中的中位评分均显著更高（mNUTRIC：5 对 3，NRS 2002：4 对 3，MUST：2 对 2；P < 0.01）。在最佳临界值时，mNUTRIC≥4 显示出最高的预后准确性（敏感性：0.77，特异性：0.74；曲线下面积[AUC] = 0.75，可信区间[CI] = 0.70 - 0.81），其次是 NRS 2002≥4（敏感性：0.63，特异性：0.60；AUC = 0.62，CI = 0.56 - 0.67）和 MUST≥3（敏感性：0.21，特异性：0.91；AUC = 0.56，CI = 0.50 - 0.68）。评分越高与疾病严重程度增加、患者表现越差、住院时间延长以及 ICU、28 天和总体医院死亡率升高相关。在这三种评估工具中，只有 mNUTRIC 评分≥4 与 ICU 死亡率独立相关（比值比[OR] = 1.54，CI = 1.21 - 1.96，P < 0.01）。
在 ICU 入院时，mNUTRIC≥4、NRS 2002≥4 和 MUST≥3 被确定为危重症 COVID-19 患者死亡率的最准确预测指标。然而，只有 mNUTRIC 评分是 ICU 死亡率的独立预测指标。
