Assessment of nutritional indices for predicting clinical outcomes in critically ill elderly patients: a prospective cohort study.

BACKGROUND

Malnutrition is a prevalent issue in critically ill elderly patients and is closely linked to poor clinical outcomes. This study aimed to assess the prognostic value of four nutritional indices-modified nutrition risk in the critically ill (mNUTRIC), Geriatric Nutritional Risk Index (GNRI), hemoglobin, albumin, lymphocyte, and platelet (HALP), and neutrophil-to-lymphocyte ratio (NLR)-in predicting intensive care unit (ICU) outcomes.

METHODS

This prospective cohort study included elderly patients (aged ≥ 65 years) who were admitted to the medical ICU of a tertiary care university hospital. Nutritional indices (mNUTRIC, GNRI, HALP, and NLR) were evaluated for their prognostic value in predicting 28-day mortality, ICU mortality, and ICU length of stay (LOS) using multivariable regression and receiver operating characteristic (ROC) curve analyses.

RESULTS

Seventy-three patients were included, with a median age (interquartile range) of 74 (10) years and 56.2% male. The mNUTRIC score was identified as an independent risk factor for 28-day mortality (OR = 2.505, 95%CI: 1.164-5.391, p = 0.019) and ICU mortality (OR = 2.736, 95%CI: 1.350-5.545, p = 0.005), with strong predictive performance (AUC: 0.864 and 0.858, respectively). It was also associated with prolonged ICU LOS (RR = 1.117, 95% CI: 1.033-1.207, p = 0.005). While GNRI exhibited good predictive performance (AUC: 0.811 and 0.799 for 28-day mortality and ICU mortality, respectively), it was not an independent factor. In contrast, HALP and NLR showed limited prognostic value for mortality.

CONCLUSIONS

The mNUTRIC score was identified as the strongest prognostic tool, with GNRI also demonstrating considerable predictive value for mortality outcomes, enhancing nutritional risk screening and clinical decision-making in elderly ICU patients.