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Nutrition Risk in the Critically Ill (NUTRIC) Score

Calculators  Multiple body systems
The Nutrition Risk in the Critically ill (NUTRIC) score identifies critically ill patients who are at high risk nutritionally and may have a better outcome if aggressive enteral or parenteral nutrition therapy is provided.
Age, years
<50 0
50–74 1
≥75 2
<15 0
15-19 1
20-27 2
≥28 3
<6 0
6–9 1
≥10 2
Number of comorbidities
0-1 0
≥2 1
Days in hospital to ICU admit
0 0
≥1 1
IL-6, µ/mL
Optional
0–399 0
≥400 1
Result:

Background

Measured Factor
Nutrition risk assessment
Measured Factor Disease
  • Malnutrition risk
  • Mortality risk
Measured Factor Detail
The NUTRIC score identifies critically ill patients who are nutritionally high-risk and may have a better outcome if aggressive enteral or parenteral nutrition therapy is provided. The score is based on age, mortality prediction scores such as the Acute Physiology And Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA Score), comorbidities, number of days from hospital admission to intensive care unit (ICU) admission, and inflammatory cytokine Interleukin 6 (optional).  Scores 0-5 indicate low risk for mortality at 28 days. Scores ≥6 indicate high risk for mortality at 28 days and aggressive nutrition therapy is advised in order to improve clinical outcome.
Speciality
Intensive Care Specialist
Body System
Multiple body systems
Measured Factor High Impact
  • Malnutrition risk associated with high mortality

Result Interpretation

Ranges Ranges
  • Critical High: Scores > 5
  • Normal: Score 0
  • Normal Adult Male: Score 0
  • Normal Adult Female: Score 0
  • Normal Geriatric Male: Score 0
  • Normal Geriatric Female: Score 0
Result High Conditions
  • Malnutrition risk
  • Mortality risk
Test Limitations
The NUTRIC score only applies to nutrition therapy providing macronutrients, protein, and energy. It does not account for other supplements important for inflammation and immunity such as arginine, glutamine, and antioxidants. Moreover, it only measures 28-day mortality and not longer term outcomes, such as 90-day mortality.
References: 1

Studies

Study Validation 1
This prospective observational cohort study investigated the association of more protein and energy intake with improved mortality in nutritionally high-risk and low-risk patients. A total of 2,853 mechanically ventilated patients in intensive care unit (ICU) greater than or equal to 4 days and a subset of 1,605 patients in ICU greater than or equal to 12 days were evaluated using the NUTRIC score. Statistical methods included logistic regression and Cox proportional hazard regression. In high-risk (NUTRIC scores ≥ 5) patients, mortality was lower with more protein intake (4-day sample: odds ratio, 0.93; 95% confidence interval (CI), 0.89-0.98; p = 0.003 and 12-day sample: odds ratio, 0.90; 95% CI, 0.84-0.96; p = 0.003) and more energy intake(4-day sample: odds ratio, 0.93; 95% CI, 0.89-0.97; p < 0.001 and 12-day sample: odds ratio, 0.88; 95% CI, 0.83-0.94; p < 0.001) intake. Additionally, high-risk patients have shorter time to discharge alive with more protein intake (4-day sample: hazard ratio, 1.05; 95% CI, 1.01-1.09; p = 0.01 and 12-day sample: hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002) and energy intake (4-day sample: hazard ratio, 1.05; 95% CI, 1.01-1.09; p = 0.02 and 12-day sample: hazard ratio, 1.09; 95% CI, 1.03-1.16; p = 0.002). The authors concluded that more nutritional intake was associated with lower mortality and faster time to discharge alive in nutritionally high-risk patients. This association was not significant in nutritionally low-risk patients.
References: 2
Study Validation 2
This study determined the association of greater nutrient intake with lower mortality in Western and Eastern critically ill patients with low body mass index (BMI).   A BMI <20 was classified as low BMI. Patients were stratified into BMI <20, BMI ≥20, nutritionally high-risk (NUTRIC scores ≥5), and nutritionally low risk (NUTRIC scores <5) groups. BMI <20 was associated with greater mortality (adjusted odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07-1.57). Among patients with low BMI and high NUTRIC scores, 10% greater protein and energy intake was associated with 5.7% and 5.5% reduction in 60-day mortality, respectively. Results were not significantly different between Western and Eastern ICU sites. The study concluded that greater protein and energy intake might reduce mortality in nutritionally high-risk patients regardless of geographic locations or low BMI.
References: 3
Study Validation 3
This retrospective analysis investigated the association between the Nutrition Risk in Critically Ill (NUTRIC) or the Nutritional Risk Screening (NRS) 2002 with protein and calories deficit in critically ill patients. A total of 312 adults were included in the study. Mean NUTRIC and NRS 2002 scores were 4 ± 2 and 4 ± 1, respectively. Each increment in NUTRIC score was associated with a 49 gram 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). NUTRIC scores >4 were associated with 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). There was no association observed between the NRS 2002 scores and protein and calories deficit. The study concluded that NUTRIC is superior to NRS 2002 in assessing malnutrition risk in critically ill patients.
References: 4
Study Additional 1
This retrospective study compared the Nutrition Risk in the Critically Ill (NUTRIC) and modified NUTRIC scores in predicting 28-day mortality in 482 intensive care unit (ICU) patients with sepsis. A modified NUTRIC score is composed of all variables except for IL-6 level in the NUTRIC score. The area under the curve for the NUTRIC Score for predicting 28-day mortality was 0.762 (95% confidence interval (CI): 0.718⁻0.806) and for the modified NUTRIC Score was 0.757 (95% CI: 0.713⁻0.801). There was no significant difference between the two scores (p = 0.45) in critically ill patients with sepsis.
References: 5

Authors

Daren Heyland, MD, MSc, FRCPC, is a critical care doctor at Kingston General Hospital and a Professor of Medicine and Epidemiology at Queen’s University, Kingston, Ontario Canada. He also serves as the Director of the Clinical Evaluation Research Unit at Kingston General Hospital.
http://www.kgh.on.ca/research/daren-heyland

References

  1. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.
  2. Compher C, Chittams J, Sammarco T, Nicolo M, Heyland DK. Greater Protein and Energy Intake May Be Associated With Improved Mortality in Higher Risk Critically Ill Patients: A Multicenter, Multinational Observational Study. Crit Care Med. 2017 Feb;45(2):156-163.
  3. Compher C, Chittams J, Sammarco T1 Higashibeppu N, Higashiguchi T, Heyland DK. Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study. JPEN J Parenter Enteral Nutr. 2018 Jun 30.
  4. Canales C, Elsayes A, Yeh DD, Belcher D, Nakayama A, McCarthy CM, et al. 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. 2018 May 30.
  5. Jeong DH, Hong SB, Lim CM, Koh Y, Seo J, Kim Y. Comparison of Accuracy of NUTRIC and Modified NUTRIC Scores in Predicting 28-Day Mortality in Patients with Sepsis: A Single Center Retrospective Study. Nutrients. 2018 Jul 17;10(7). pii: E911.