Application of modified Nutrition Risk in the Critically Ill score to critically ill elderly patients

doi:10.3969/j.issn.1674-8115.2022.01.003

Abstract

Abstract: Objective

·To validate the role of the modified Nutrition Risk in the Critically Ill (mNUTRIC) score in the assessment of nutritional risk and clinical prognosis in critically ill elderly patients.

Methods

·A prospective observational study was carried out. The mNUTRIC score was employed to assess the nutritional risk of elderly patients who were admitted into the intensive care unit (ICU) of Shanghai General Hospital, Shanghai Jiao Tong University between October 2020 and February 2021. Patients were divided into high nutritional risk group and low nutritional risk group based on the mNUTRIC score results. The observational end-points were transferred, discharged or death. Different nutrition risk patients' nutritional support were analyzed, including nutritional support methods, the time period before nutritional support, and energy supply conditions. The length of ICU stay, days with mechanical ventilation, and 28-day mortality of different nutrition risk patients were compared.

Results

·Among critically ill elderly patients, 51.8% were at high nutritional risk. The energy compliance rate of the low nutritional risk group was 73.3%, and that of the high nutritional risk group was 58.8%. It took 5.00 (1.00, 8.00) d for the low nutritional risk group and 9.00 (3.00, 12.50) d for the high nutritional risk group to reach the energy standard. There was no statistical difference in the nutritional support methods, the time period before nutritional support, and energy supply conditions between the two groups. The mechanical ventilation time of the high nutritional risk group was 5.00 (1.50, 12.50) d, longer than that of the low nutritional risk group (P=0.018). The 28-day mortality rate of the high nutritional risk group was 47.7%, higher than that of the low nutritional risk group (P=0.001). There was no statistical difference in ICU stay between the two groups.

Conclusion

·mNUTRIC score can be used to evaluate nutritional risk and predict the clinical prognosis of critically ill elderly patients. It is suggested that stratified clinical nutrition management should be carried out for the critically ill elderly patients with different nutritional risks. Critically ill elderly patients can benefit from personalized nutritional support programs, and the clinical prognosis of patients may be improved.

Key words: critical care, aged, nutrition assessment, prognosis, nutritional support

CLC Number:

R153.3

Xuemei LU, Lan CHEN. Application of modified Nutrition Risk in the Critically Ill score to critically ill elderly patients[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 16-20.

Figures/Tables 3

TrendMD

References 19

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Item	High-risk group （n=44）	Low-risk group （n=41）	χ²/t value	P value
Gender/n（%）			1.190	0.275
Male	25 （56.8）	28 （68.3）
Female	19 （43.2）	13 （31.7）
BMI/（kg·m^-2）	23.75±3.77	22.05±3.30	-2.198	0.031
Diagnosis/n（%）			6.825	0.326
Digestive disease	13 （29.6）	12 （29.3）
Respiratory disease	10 （22.7）	11 （26.8）
Circulatory disease	6 （13.6）	2 （4.9）
Neurological disease	4 （9.1）	3 （7.3）
Sepsis	9 （20.5）	5 （12.2）
Others	2 （4.5）	8 （19.5）

Item	High-risk group （n=44）	Low-risk group （n=41）	χ²/t value	P value
Gender/n（%）			1.190	0.275
Male	25 （56.8）	28 （68.3）
Female	19 （43.2）	13 （31.7）
BMI/（kg·m^-2）	23.75±3.77	22.05±3.30	-2.198	0.031
Diagnosis/n（%）			6.825	0.326
Digestive disease	13 （29.6）	12 （29.3）
Respiratory disease	10 （22.7）	11 （26.8）
Circulatory disease	6 （13.6）	2 （4.9）
Neurological disease	4 （9.1）	3 （7.3）
Sepsis	9 （20.5）	5 （12.2）
Others	2 （4.5）	8 （19.5）

Item	High-risk group （n=44）	Low-risk group （n=41）	χ²/Z value	P value
Nutritional support/n（%）			0.558	0.906
No	10 （22.7）	11 （26.8）
EN	14 （31.8）	14 （34.2）
PN	5 （11.4）	5 （12.2）
EN+PN	15 （34.1）	11 （26.8）
Time period before EN/d	10.00 （4.50， 12.00）	5.00 （3.50， 9.00）	-8.410	0.400
Time period before PN/d	4.00 （2.00， 13.00）	7.00 （4.00， 15.50）	-1.605	0.108
Energy goal/n（%）			1.487	0.223
Yes	20 （58.8）	22 （73.3）
No	14 （41.2）	8 （26.7）
Time to achieve energy goal/d	9.00 （3.00， 12.50）	5.00 （1.00， 8.00）	-1.511	0.131

Item	High-risk group （n=44）	Low-risk group （n=41）	χ²/Z value	P value
Nutritional support/n（%）			0.558	0.906
No	10 （22.7）	11 （26.8）
EN	14 （31.8）	14 （34.2）
PN	5 （11.4）	5 （12.2）
EN+PN	15 （34.1）	11 （26.8）
Time period before EN/d	10.00 （4.50， 12.00）	5.00 （3.50， 9.00）	-8.410	0.400
Time period before PN/d	4.00 （2.00， 13.00）	7.00 （4.00， 15.50）	-1.605	0.108
Energy goal/n（%）			1.487	0.223
Yes	20 （58.8）	22 （73.3）
No	14 （41.2）	8 （26.7）
Time to achieve energy goal/d	9.00 （3.00， 12.50）	5.00 （1.00， 8.00）	-1.511	0.131

Item	High-risk group （n=44）	Low-risk group （n=41）	χ²/Z value	P value
Length of stay in ICU/d	12.00 （7.50， 19.00）	13.00 （8.00， 17.00）	-0.229	0.819
Mechanical ventilation time/d	5.00 （1.50， 12.50）	1.00 （0.00， 7.00）	-2.371	0.018
28-day mortality/n（%）	21 （47.7）	6 （14.6）	10.724	0.001