Association of modified NUTRIC score for nutritional risk and in-hospital developed malnutrition in adults with severe injuries: a prospective observational cohort study

Abstract

Background: This study investigated the prevalence of high nutritional risk (modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5) and its relation with malnutrition and other adverse in-hospital outcomes in severely injured patients (Injury Severity Score ≥ 16), admitted to the ICU. We hypothesized that high nutritional risk is associated with an increased risk of developing malnutrition (primary hypothesis) and of complications and mortality (secondary hypotheses) in adults with severe injuries compared to those with low nutrition risk. Methods: In this observational prospective study, 100 severely injured patients admitted to the ICU of five Level-1 trauma centers in the US and the Netherlands between 2018–2022 were included. During ICU and hospital stay, malnutrition rates (Subjective Global Assessment score ≤ 5), complication rates (systemic complications, pneumonia, urinary tract infection, venous thromboembolism), and mortality of severely injured patients with high versus low nutritional risk were compared. A cause-specific Cox regression model was fitted to analyze whether high nutritional risk was related to developing malnutrition. Results: Eighteen percent of patients had high nutritional risk (95% confidence interval [CI] 10.5–25.5%) at admission. High nutritional risk was not related to in-ICU or in-hospital developed malnutrition. In patients with high nutritional risk, the hazard ratio for developing malnutrition was 1.3 (95% CI 0.7–2.6, p = 0.45). Severely injured patients with high nutritional risk had more complications during ICU (78% vs 29%, p < 0.001; OR 8.5, 95% CI 2.5–28.3) and hospital stay (83% vs 41%, p < 0.01; OR 6.0, 95% CI 1.5–24.9). ICU mortality (22% vs 4%, p = 0.02; OR 7.5, 95% CI 1.5–37.3) and hospital mortality (33% vs 6%, p < 0.01; OR 5.9, 95% CI 1.3–26.4) were also higher in patients with high nutritional risk. Conclusion: About one-fifth of severely injured patients admitted to the ICU had high nutritional risk. High nutritional risk in severely injured patients is not associated with malnutrition. It is potentially associated with adverse in-hospital outcomes. Level of evidence: Level III, Prognostic/Epidemiological.