Two variants of the Nutritional Risk in the Critically Ill Score as predictors of mortality in Intensive Care Unit patients at a Brazilian University Hospital

SILVA, Amanda Forte dos Santos; REIS, Audrey Machado dos; MARCHETTI, Julia; FRANZOSI, Oellen Stuani; STEEMBURGO, Thais

doi:10.1590/1678-9865202033e190031

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL • Rev Nutr 33 • 2020 • https://doi.org/10.1590/1678-9865202033e190031 copy

Two variants of the Nutritional Risk in the Critically Ill Score as predictors of mortality in Intensive Care Unit patients at a Brazilian University Hospital

Duas variantes do Escore de Risco Nutricional em Pacientes Críticos como preditoras de mortalidade em pacientes admitidos em uma Unidade de Terapia Intensiva de um Hospital Universitário Brasileiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To evaluate the agreement between the modified version of the Nutritional Risk in the Critically Ill Score (without Interleukin-6) and a variant composed of C-Reactive Protein as well as its capacity to predict mortality.

Methods

A prospective cohort study was carried out with 315 patients in an Intensive Care Unit of a university hospital from October 2017 to April 2018. The agreement between the instruments was evaluated using the Kappa test. The predictive capacity for estimating mortality was assessed with the Receiver Operating Characteristic curve.

Results

The critical patients involved in the study had a mean age of 60.8±16.3 years and 53.5% were female. Most patients had C-Reactive Protein levels ?10mg/dL (n=263, 83.5%) and their admission in the Intensive Care Unit was medical (n=219, 69.5%). The prevalence of mortality was observed in 41.0% of the evaluated patients. The proportions at high nutritional risk according to Nutritional Risk in the Critically Ill without Interleukin-6 and with C-Reactive Protein were 57.5% and 55.6%, respectively. The tools showed strong and significant agreement(Kappa=0.935; p=0.020) and satisfactory performances in predicting mortality (area under the curve 0.695 [0.636-0.754] and 0.699 [0.640-0.758]).

Conclusion

Both versions of the Nutritional Risk in the Critically Ill tool show a satisfactory agreement and performance as predictors of mortality in critically ill patients. Further analysis of this variant and the association between nutrition adequacy and mortality is needed.

Keywords
Critical illness; Intensive Care Unit; Nutritional assessment

Clinical characteristics		Survivors (n=186)	Non-survivors (n=129)	p-value
Age (years)¹ 1 Mean and Standard Deviation;		58.1±16.6	64.6±15.0	<0.278^* * t Student Test;
BMI (kg/m²)¹ 1 Mean and Standard Deviation;		27.5±7.0	24.8±5.4	<0.133^* * t Student Test;
APACHE II (score)¹ 1 Mean and Standard Deviation;		18.0±6.3	22.5±7.4	<0.001^* * t Student Test;
SOFA (score)² 2 Median (P25-P75);		5.0 (2.0-8.0)	7.0 (4.0-11.0)	<0.001^ Mann-Whitney U Test;
CRP (mg/dl)² 2 Median (P25-P75);		68.7 (17.2-146.6)	103.4 (38.6-205.8)	<0.005^ Mann-Whitney U Test;
Hospital LOS (days)² 2 Median (P25-P75);		20.0 (14.7-33.2)	14.0 (8.0-30.0)	<0.001^ Mann-Whitney U Test;
ICU LOS (days)² 2 Median (P25-P75);		5.0 (3.0-9.0)	6.0 (3.0-12.0)	<0.114^ Mann-Whitney U Test;
ICU FREE-DAYS² 2 Median (P25-P75);		11.0 (4.0-20.2)	12.0 (4.0-23.0)	<0.486^ Mann-Whitney U Test;
Readmission in ICU (yes)³ 3 Number and prevalence (%).		19 (10.2%)	17 (13.2%)	<0.416^* ***** χ2 test;
Infection (yes)³ 3 Number and prevalence (%).		106 (57.0%)	71 (55.0%)	<0.732^* ***** χ2 test;
NUTRIC-1² 2 Median (P25-P75); ,^a a Without Interleukin-6;		4.0 (1.0-9.0)	6.0 (2.0-13.0)	<0.001^ Mann-Whitney U Test;
	Score ≥5-9 points³ 3 Number and prevalence (%). ,^† † Result considered as high nutritional risk;	85 (47.0%)	96 (53.0%)	<0.001^* ***** χ2 test;
NUTRIC-2² 2 Median (P25-P75); ,^b b Included C-Reactive Protein (mg/dL);		5.0 (2.0-10.0)	7.0 (2.0-14.0)	<0.001^ Mann-Whitney U Test;
	Score ≥6-10 points³ 3 Number and prevalence (%). ,^† † Result considered as high nutritional risk;	79 (45.1%)	96 (55.0%)	<0.001^* ***** χ2 test;

Outcomes	NUTRIC-1^a a Without IL-6;			NUTRIC-2^b b Included C-Reactive Protein (mg/dL);
Outcomes	Score <5-9 points	Score ≥5-9 points^† † Results considered as high nutritional risk.	p-value	Score <6-10 points	Score ≥6-10 points^† † Results considered as high nutritional risk.	p-value
Hospital LOS (days)	18.0 (10.7-31.0)¹ 1 Median (P25-P75);	19.0 (11.5-32.0)¹ 1 Median (P25-P75);	0.913^* * Mann-Whitney U Test;	5.0 (3.0-9.0)¹ 1 Median (P25-P75);	18.0 (11.0-32.0)¹ 1 Median (P25-P75);	0.835^* * Mann-Whitney U Test;
ICU LOS (days)	5.0 (3.0-9.0)¹ 1 Median (P25-P75);	7.0 (4.0-11.0)¹ 1 Median (P25-P75);	0.002^* * Mann-Whitney U Test;	2.7 (1.0-7.4)¹ 1 Median (P25-P75);	5.0 (3.0-9.0)¹ 1 Median (P25-P75);	0.004^* * Mann-Whitney U Test;
ICU free-days (days)	10.0 (4.0-20.5)¹ 1 Median (P25-P75);	12.0 (4.0-22.5)¹ 1 Median (P25-P75);	0.555^* * Mann-Whitney U Test;	10.5 (4.0-21.0)¹ 1 Median (P25-P75);	12.0 (4.0-22.0)¹ 1 Median (P25-P75);	0.688^* * Mann-Whitney U Test;
Readmission ICU (yes)	16 (44.4%)² 2 Number and prevalence (%);	20 (55.6%)² 2 Number and prevalence (%);	0.806^ χ2 Test;	17 (47.2%)² 2 Number and prevalence (%);	19 (52.8%)² 2 Number and prevalence (%);	0.722^ χ2 Test;
Infection (yes)	76 (42.9%)² 2 Number and prevalence (%);	101 (57.1%)² 2 Number and prevalence (%);	0.871^ χ2 Test;	79 (44.6%)² 2 Number and prevalence (%);	99 (55.4%)² 2 Number and prevalence (%);	0.939^ χ2 Test;
Death (yes)	134 (42.5%)² 2 Number and prevalence (%);	181 (57.5%)² 2 Number and prevalence (%);	<0.001^ χ2 Test;	140 (44.4%)² 2 Number and prevalence (%);	175 (55.6%)² 2 Number and prevalence (%);	<0.001^ χ2 Test;

Nutrition screening tool	Sensitivity(%)	Specificity(%)	Performance (ROC-AUC)
NUTRIC-1^a a Without Interleukin-6;	74.4	45.7	0.695 (0.636-0.754)
NUTRIC-2^b b Included C-Reactive Protein.	73.6	42.5	0.699 (0.640-0.758)

Pontifícia Universidade Católica de Campinas Núcleo de Editoração SBI - Campus II , Av. John Boyd Dunlop, s/n. - Prédio de Odontologia, 13059-900 Campinas - SP Brasil, Tel./Fax: +55 19 3343-6875 - Campinas - SP - Brazil
E-mail: sbi.submissionrn@puc-campinas.edu.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence to: T. STEEMBURGO. E-mail: tsteemburgo@gmail.com.