Prediction of mortality in patients admitted to the intensive care unit due to respiratory failure; use of nutritional screening tools mNUTRIC and NRS-2002

Authors : Onur Küçük, Fatih Seğmen, Semih Aydemir

Pages : 111-119

Doi:10.38053/acmj.1608252

View : 145 | Download : 185

Publication Date : 2025-03-21

Article Type : Research Paper

Abstract :Aims: The objective of this study was to examine the effectiveness of the nutritional screening tools modified nutrition risk in the critically ill (mNUTRIC) and nutrition risk screening-2002 (NRS-2002) in predicting mortality among patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) and to determine if their effectiveness varies by respiratory failure (RF) type. Methods: This prospective, cohort, descriptive study was initiated after ethics committee approval. During a 6-month period, all adult patients (aged ≥18 years) admitted to the tertiary ICUs with acute RF, with type 1 and type 2 RF, who stayed for more than 48 hours were included. Patients were divided into two groups: survivors and non-survivors. Nutritional screening was performed with mNUTRIC and NRS-2002. Scores of 5 points or more on any of the nutritional tools were considered to indicate high nutritional risk. Multiple logistic regression analysis was used to test data predicting 1-month (30-day) and 3-month (90-day) mortality. Relative risk (RR) values of the nutritional tools on mortality were calculated. Results: Among 525 patients, 35.4% had type 1 RF, and 64.6% had type 2 RF. The mortality rates were 44.2% at one month and 62.5% at three months, with higher mortality observed in type 1 RF in both periods. The mNUTRIC score, the presence of inotropic support, type 1 RF, and admission from the ward were identified as independent variables with a significant association with mortality at 1 and 3 months. The mNUTRIC score emerged as the variable most strongly associated with mortality in both periods. When the mNUTRIC score was evaluated in isolation, the optimal cut-off value was determined to be 6 (1-month mortality AUC: 0.77, 3-month mortality AUC: 0.82). Patients with nutritional risk, as identified by mNUTRIC, exhibited a fourfold elevated risk of mortality within one month (RR=4.2; 95% CI: 2.56–6.95; p<.001) and three months (RR=4.6; 95% CI: 3.04–7.15; p<.001). Combining mNUTRIC and NRS-2002 scores did not significantly enhance predictive accuracy compared to mNUTRIC alone. Conclusion: In patients with RF, the mNUTRIC score is the most powerful parameter for identifying the high-risk group. The prognosis is worse in patients with type 1 RF compared to type 2. Especially in the group of patients with high mNUTRIC score, in need of inotropic support, type 1 RF findings, and the need for ICU during hospitalization, early intervention and management in terms of nutrition is important to improve the duration of intensive care stay and mortality rates.
Keywords : akut solunum yetmezliği, yoğun bakım ünitesi, mortalite, mNUTRIC, NRS-2002

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