Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients?

JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):81-87. doi: 10.1002/jpen.1181. Epub 2018 May 30.

Abstract

Background: Malnutrition influences clinical outcomes. Although various screening tools are available to assess nutrition status, their use in the intensive care unit (ICU) has not been rigorously studied. Our goal was to compare the Nutrition Risk in Critically Ill (NUTRIC) to the Nutritional Risk Screening (NRS) 2002 in terms of their associations with macronutrient deficit in ICU patients.

Methods: We performed a retrospective analysis to investigate the relationship between NUTRIC vs NRS 2002 and macronutrient deficit (protein and calories) in critically ill patients. We performed linear regression analyses, controlling for age, sex, race, body mass index, and ICU length of stay. We then dichotomized our primary exposures and outcomes to perform logistic regression analyses, controlling for the same covariates.

Results: The analytic cohort included 312 adults. Mean NUTRIC and NRS 2002 scores were 4 ± 2 and 4 ± 1, respectively. Linear regression demonstrated that each increment in NUTRIC score was associated with a 49 g higher protein deficit (β = 48.70: 95% confidence interval [CI] 29.23-68.17) and a 752 kcal higher caloric deficit (β = 751.95; 95% CI 447.80-1056.09). Logistic regression demonstrated that NUTRIC scores >4 had over twice the odds of protein deficits ≥300 g (odds ratio [OR] 2.35; 95% CI 1.43-3.85) and caloric deficits ≥6000 kcal (OR 2.73; 95% CI 1.66-4.50) compared with NUTRIC scores ≤4. We did not observe an association of NRS 2002 scores with macronutrient deficit.

Conclusion: Our data suggest that NUTRIC is superior to NRS 2002 for assessing malnutrition risk in ICU patients. Randomized, controlled studies are needed to determine whether nutrition interventions, stratified by NUTRIC score, can improve patient outcomes.

Keywords: NRS 2002; NUTRIC; critical care; intensive care unit; nutrition.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Body Mass Index
  • Critical Care
  • Critical Illness*
  • Dietary Proteins / administration & dosage
  • Energy Intake
  • Female
  • Humans
  • Intensive Care Units*
  • Length of Stay
  • Logistic Models
  • Male
  • Malnutrition / diagnosis*
  • Mass Screening / methods*
  • Middle Aged
  • Nutrition Assessment*
  • Nutritional Status*
  • Odds Ratio
  • Retrospective Studies
  • Risk Assessment

Substances

  • Dietary Proteins