Initial development and validation of a novel nutrition risk, sarcopenia, and frailty assessment tool in mechanically ventilated critically ill patients: The NUTRIC-SF score

• Main Authors: Lee, Zheng-Yii, Hasan, Mohd Shahnaz, Day, Andrew G., Ng, Ching Choe, Ong, Su Ping, Yap, Cindy Sing Ling, Engkasan, Julia Patrick, Barakatun-Nisak, Mohd Yusof, Heyland, Daren K.
• Format: Article
• Published: Wiley 2022
• Subjects: QP Physiology; RM Therapeutics. Pharmacology
• Online Access: http://eprints.um.edu.my/33816/
• Institution: Universiti Malaya

Background Nutrition risk, sarcopenia, and frailty are interrelated. They may be due to suboptimal or prevented by optimal nutrition intake. The combination of nutrition risk (modified nutrition risk in the critically ill mNUTRIC]), sarcopenia (SARC-F combined with calf circumference SARC-CALF]), and frailty (clinical frailty scale CFS]) in a single score may better predict adverse outcomes and prioritize resources for optimal nutrition in the intensive care unit (ICU) Methods This is a retrospective analysis of a single-center prospective observational study that enrolled mechanically ventilated adults with expected >= 96 h of ICU stay. SARC-F and CFS questionnaires were administered to patient's next-of-kin and mNUTRIC were calculated. Right calf circumference was measured. Nutrition data were collected from nursing record. The high-risk scores (mNUTRIC >= 5, SARC-CALF > 10, or CFS >= 4) of these variables were combined to become the nutrition risk, sarcopenia, and frailty (NUTRIC-SF) score (range: 0-3). Results Eighty-eight patients were analyzed. Increasing mNUTRIC was independently associated with 60-day mortality, whereas increasing SARC-CALF and CFS showed a strong trend towards a higher 60-day mortality. Discriminative ability of NUTRIC-SF for 60-day mortality is better than its component (C-statistics, 0.722; 95% confidence interval CI], 0.677-0.868). Every increment of 300 kcal/day and 30 g/day is associated with a trend towards higher rate of discharge alive for high (>= 2; adjusted hazard ratio, 1.453 95% CI, 0.991-2.130] for energy; 1.503 0.936-2.413] for protein) but not low (<2) NUTRIC-SF score. Conclusion NUTRIC-SF may be a clinically relevant risk stratification tool in the ICU.