Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 15 (6), R268

Identifying Critically Ill Patients Who Benefit the Most From Nutrition Therapy: The Development and Initial Validation of a Novel Risk Assessment Tool


Identifying Critically Ill Patients Who Benefit the Most From Nutrition Therapy: The Development and Initial Validation of a Novel Risk Assessment Tool

Daren K Heyland et al. Crit Care.


Introduction: To develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU).

Methods: A prospective, observational study of patients expected to stay > 24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) < 20, estimated % oral intake in the week prior, weight loss in the last 3 months and serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels. Approximate quintiles of each variable were assigned points based on the strength of their association with 28 day mortality.

Results: A total of 597 patients were enrolled in this study. Based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI, CRP, PCT, estimated percentage oral intake and weight loss. As the score increased, so did mortality rate and duration of mechanical ventilation. Logistic regression demonstrated that nutritional adequacy modifies the association between the score and 28 day mortality (p = 0.01).

Conclusions: This scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy.


Figure 1
Figure 1
Conceptual model for nutrition risk assessment in the critically ill. APACHE, Acute physiology and chronic health evaluation score; BMI, body mass index; CRP, C-reactive protein; IL-6, interleukin 6; PCT, procalcitonin; SOFA, sequential organ failure assessment score.
Figure 2
Figure 2
Relation between NUTRIC score and 28-day mortality. NUTRIC, Nutrition Risk in the Critically Ill Score.
Figure 3
Figure 3
Relation between NUTRIC score and duration of mechanical ventilation among 28-day survivors. NUTRIC, Nutrition Risk in the Critically Ill Score.
Figure 4
Figure 4
Predicted probability of 28-day mortality versus percent of caloric. Prescription received for patients with low (n = 114) and high (n = 97) NUTRIC score. Lines and shading are the predicted probability and 95% confidence intervals based on logistic regression. Circles and plus symbols indicate the observed values for the subgroup of 211 patients evaluable for assessment of nutritional adequacy. NUTRIC, Nutrition Risk in the Critically Ill Score.

Comment in

Similar articles

See all similar articles

Cited by 64 PubMed Central articles

See all "Cited by" articles


    1. Kondrup J, Allison SP, ELia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003;22(4):415–421. doi: 10.1016/S0261-5614(03)00098-0. - DOI - PubMed
    1. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G. A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN J Parenter Enteral Nutr. 2009;33(3):277–316. doi: 10.1177/0148607109335234. - DOI - PubMed
    1. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–336. doi: 10.1016/S0261-5614(02)00214-5. - DOI - PubMed
    1. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? 1987. Classical article. Nutr Hosp. 2008;23(4):400–407. - PubMed

Publication types

MeSH terms