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

  • Xuemei LU ,
  • Lan CHEN
Expand
  • 1.School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China
    2.Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
CHEN Lan, E-mail: 13636317690@126.com.

Received date: 2021-06-21

  Online published: 2022-01-28

Supported by

Program of Shanghai Municipal Health Commission(201940074)

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.

Cite this article

Xuemei LU , Lan CHEN . Application of modified Nutrition Risk in the Critically Ill score to critically ill elderly patients[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022 , 42(1) : 16 -20 . DOI: 10.3969/j.issn.1674-8115.2022.01.003

References

1 VRANE?I? B D, KRZNARI? ?. Nutritional issues and considerations in the elderly: an update[J]. Croat Med J, 2020, 61(2): 180-183.
2 CHEN S, CUI Y, DING Y P, et al. Prevalence and risk factors of dysphagia among nursing home residents in eastern China: a cross-sectional study[J]. BMC Geriatr, 2020, 20(1): 352.
3 KIMURA A, SUGIMOTO T, KITAMORI K, et al. Malnutrition is associated with behavioral and psychiatric symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer's disease[J]. Nutrients, 2019, 11(8): 1951.
4 SHPATA V, OHRI I, NURKA T, et al. The prevalence and consequences of malnutrition risk in elderly Albanian intensive care unit patients[J]. Clin Interv Aging, 2015, 10: 481-486.
5 TRIPATHY S, MISHRA J C. Assessing nutrition in the critically ill elderly patient: a comparison of two screening tools[J]. Indian J Crit Care Med, 2015, 19(9): 518-522.
6 ZHU M, WEI J, CHEN W, et al. Nutritional risk and nutritional status at admission and discharge among Chinese hospitalized patients: a prospective, nationwide, multicenter study[J]. J Am Coll Nutr, 2017, 36(5): 357-363.
7 HEYLAND D K, DHALIWAL R, JIANG X, et al. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool[J]. Crit Care, 2011, 15(6): R268.
8 RAHMAN A, HASAN R M, AGARWALA R, et al. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool[J]. Clin Nutr, 2016, 35(1): 158-162.
9 JEONG D, HONG S B, LIM C M, et al. Comparison of accuracy of NUTRIC and modified NUTRIC scores in predicting 28-day mortality in patients with sepsis: a single center retrospective study[J]. Nutrients, 2018, 10(7): 911.
10 林靖, 阿斯楞, 王婧超, 等. Nutric评分与改良nutric评分在成人重症患者营养评估中的应用进展[J]. 临床和实验医学杂志, 2020, 19(15): 1674-1676.
11 SINGER P, BLASER A R, BERGER M M, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019, 38(1): 48-79.
12 LEE Z Y, HEYLAND D K. Determination of nutrition risk and status in critically ill patients: what are our considerations? [J]. Nutr Clin Pract, 2019, 34(1): 96-111.
13 FELDBLUM I, GERMAN L, CASTEL H, et al. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status[J]. Nutr J, 2007, 6: 37.
14 VOLKERT D, BECK A M, CEDERHOLM T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics[J]. Clin Nutr, 2019, 38(1): 10-47.
15 REIS A M D, FRUCTHENICHT A V G, MOREIRA L F. NUTRIC score use around the world: a systematic review[J]. Rev Bras Ter Intensiva, 2019, 31(3): 379-385.
16 何多奇, 张西强, 云慧斌, 等. 谷氨酰胺强化鼻空肠管营养对老年重症颅脑损伤患者肠黏膜屏障及免疫功能的影响[J]. 上海交通大学学报(医学版), 2015, 35(5): 785-788.
17 刘骅, 凌伟, 曹晖. 免疫强化肠内与肠外营养对老年胃癌患者全胃切除术后营养和免疫功能的影响[J]. 上海交通大学学报(医学版), 2011, 31(7): 1000-1004.
18 刘彩云, 杜红娣, 李薇, 等. 基于临床护理路径的营养支持对阿尔茨海默病老年住院患者营养状况和生活质量的影响[J]. 中华临床营养杂志, 2019, 27(5): 287-292.
19 卢少萍, 徐永能, 任晓晓, 等. 延续性营养护理服务对改善老年卧床患者营养状况的效果[J]. 中国护理管理, 2018, 18(12): 1678-1681.
Outlines

/