Article: The modified NUTRIC score (mNUTRIC) is associated with increased 28-day mortality in critically ill COVID-19 patients: Internal validation of a prediction model
Clinical nutrition ESPEN. 2022 Apr., v. 48
2022
Abstract: High prevalence of malnutrition was found in critically ill COVID-19 patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score is frequently used for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. The aim of ...
| Abstract | High prevalence of malnutrition was found in critically ill COVID-19 patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score is frequently used for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. The aim of this study was to investigate the role of mNUTRIC score to predict 28-day mortality in critically ill COVID-19 patients admitted to ICU. A cohort of consecutive COVID-19 critically ill patients admitted to ICU was retrospectively evaluated and the nutritional risk was assessed with the use of mNUTRIC score. A multivariable Cox regression model to predict 28-day mortality was therefore developed including the mNUTRIC as a covariate. Internal validation was performed using the bootstrap resampling technique to reduce possible bias in the estimated risks. The performance of the prediction model was assessed via calibration and discrimination. A total of 98 critically ill COVID-19 patients with a median age of 66 years (56–73 IQR), 81 (82.7%) males were included in this study. A high nutritional risk (mNUTRIC ≥5 points) was observed in 41.8% of our critically ill COVID-19 patients while a low nutritional risk (mNUTRIC <5 points) was observed in 58.2%. Forty-five patients (45.9%) died within 28 days after ICU admission. In multivariable model after internal validation, mNUTRIC ≥5 (optimism adjusted HR 2.38, 95% CI 1.08–5.25, p = 0.02) and high-sensitivity C-reactive protein values (CRP) (optimism adjusted HR 1.02, 95% CI 1.01–1.07, p = 0.005) were independent predictors of 28-day mortality. A high prevalence of malnutrition as revealed by mNUTRIC was found in our critically ill COVID-19 patients once admitted in ICU. After adjustment for covariables, mNUTRIC ≥5 and CRP levels were independently associated with 28-day mortality in critically ill COVID-19 patients. The final model revealed good discrimination and calibration. Nutritional risk assessment is essential for the management of critically ill COVID-19 patients as well as for outcome prediction. |
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| Keywords | C-reactive protein ; COVID-19 infection ; clinical nutrition ; malnutrition ; models ; mortality ; nutrition risk assessment ; prediction ; regression analysis ; risk |
| Language | English |
| Dates of publication | 2022-04 |
| Size | p. 202-209. |
| Publishing place | Elsevier Ltd |
| Document type | Article |
| ISSN | 2405-4577 |
| DOI | 10.1016/j.clnesp.2022.02.014 |
| Database | NAL-Catalogue (AGRICOLA) |
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