Identification of ICU Patients with High Nutritional Risk after Abdominal Surgery Using Modified NUTRIC Score and the Association of Energy Adequacy with 90-Day Mortality

Abstract

For patients undergoing abdominal surgery, malnutrition further increases the susceptibility to infection, surgical complications, and mortality. However, there is no standard tool for identifying high-risk groups of malnutrition or exact criteria for the optimal target of nutrition supply. We aimed to identify the nutritional risk in critically ill patients using modified Nutrition Risk in the Critically Ill (mNUTRIC) scores and assessing the relationship with clinical outcomes. Furthermore, we identified the ideal target of energy intake during the acute postoperative period. A prospective observational study was conducted. mNUTRIC scores and the average calories prescribed and given were calculated. To identify the high-risk group of malnutrition, receiver operating characteristic curves were plotted. The ideal target of energy adequacy and predisposing factors of 90-day mortality were assessed using multiple logistic regression analyses. A total of 206 patients were analyzed. The cutoff value for mNUTRIC score predicting 90-day mortality was 5 (Area under the curve = 0.7, 95% confidence interval (Cl) 0.606–0.795, p < 0.001). A total of 75 patients (36.4%) were classified in the high mNUTRIC group (mNUTRIC ≥ 5) and had a significantly higher postoperative complication and longer length of surgical intensive care unit stay. High mNUTRIC scores (odds ratio = 2.548, 95% CI 1.177–5.514, p = 0.018) and energy adequacy less than 50% (odds ratio = 6.427, 95% CI 1.674–24.674, p = 0.007) were associated with 90-day mortality.