Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool
Open accessAbstract
Introduction: To develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU). Methods: A prospective, observational study of patients expected to stay > 24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) < 20, estimated % oral intake in the week prior, weight loss in the last 3 months and serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels. Approximate quintiles of each variable were assigned points based on the strength of their association with 28 day mortality. Results: A total of 597 patients were enrolled in this study. Based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI, CRP, PCT, estimated percentage oral intake and weight loss. As the score increased, so did mortality rate and duration of mechanical ventilation. Logistic regression demonstrated that nutritional adequacy modifies the association between the score and 28 day mortality (p = 0.01). Conclusions: This scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy.
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The Nutrition Risk in Critically ill (NUTRIC) score could not differentiate among these patients.
“The Nutrition Risk in Critically ill (NUTRIC) score could not differentiate among these patients [20].”
From Nutrition in Sepsis: A Bench-to-Bedside Review. (2020) · cites this paper as [20]
The Results report that the NUTRIC score discriminated 28-day mortality risk (c-index = 0.783) and that its discriminative capacity remained strong in split-sample validation. The Discussion also says it distinguished patients more likely to benefit from increased protein-energy provision. The citing sentence does not identify which patients “these patients” refers to, but the paper makes the contrary point for the critically ill patients it studied. (LLM, conf=0.85)
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Experimental — accuracy not yet measuredNUTRIC is a novel risk assessment tool merely based on the severity of disease.
“NUTRIC (¼ nutritional risk in critically ill) is a novel risk assessment tool merely based on the severity of disease was proposed [10].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [10]
The Introduction identifies NUTRIC as a novel risk-assessment tool. But the Results describe a final score with six variables, not one based merely on disease severity; these include age and other factors alongside APACHE II and SOFA scores. The Results also say that weight loss and oral intake were excluded from the final score. (LLM, conf=0.90)
Experimental — accuracy not yet measuredInitiating supplemental PN on top of EN prior to day 7-10 after ICU admission does not improve clinical outcome and may have detrimental consequences.
“This statement is based on the evaluation that initiating supplemental PN on top of EN prior to day 7-10 after ICU admission does not improve clinical outcome and even may have detrimental consequences.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [43]
The Methods describe EN and PN use but do not assess when supplemental PN was initiated relative to day 7–10. The Discussion links greater protein-energy provision to better outcomes in high-NUTRIC-score patients and possible harm in low-score patients, but does not establish the claimed outcome of early supplemental PN. Searches for the day 7–10 timing and detrimental consequences found no passage addressing that specific claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe BMI cutoff for lower energy provision and high protein supply in reported recommendations was mostly 30 kg/m2.
“The BMI cutoff for lower energy provision and high protein supply was mostly 30 kg/m 2 .”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [43]
The Introduction discusses outcomes associated with increased calorie and protein intake across BMI groups, using thresholds of 25 and 35 kg/m². It does not describe recommendations for lower energy and high protein provision at a BMI cutoff of 30 kg/m². Searches for that cutoff and for hypocaloric, high-protein guidance found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe ASPEN and Surviving Sepsis Recommendations do not acknowledge any advantage to new lipid emulsions.
“The ASPEN (43) and Surviving Sepsis Recommendations (113) do not acknowledge any advantage to new lipid emulsions.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [43]
The Discussion addresses the NUTRIC score and nutrition delivery, not the advantages of new lipid emulsions. The References list an A.S.P.E.N. guideline, but our copy does not describe its position on lipid emulsions or the Surviving Sepsis recommendations. Searches for both recommendations and lipid emulsions found no passage addressing the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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Cites
(1990) · Choice Reviews Online · doi:10.5860/choice.27-3338 · Cited by 35,305 · see citing works
Hosmer, D. W., & Lemeshow, S. (2000) · doi:10.1002/0471722146 · Cited by 20,302 · see citing works
Flagged first, then by citations
Research works printed but not linked: 24
- Kondrup J Allison SP ELia M Vellas B Plauth M ESPEN Guidelines for Nutrition Screening 2002 Clin Nutr 2003 22 4 415 421 10.1016/S0261-5614(03)00098-0 12880610 · DOI · Paper page
- McClave SA Martindale RG Vanek VW McCarthy M Roberts P Taylor B Ochoa JB Napolitano L Cresci G A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) JPEN J Parenter Enteral Nutr 2009 33 3 277 316 10.1177/0148607109335234 19398613 · DOI · Paper page
- Kondrup J Rasmussen HH Hamberg O Stanga Z Ad Hoc ESPEN Working Group Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials Clin Nutr 2003 22 3 321 336 10.1016/S0261-5614(02)00214-5 12765673 · DOI · Paper page
- Detsky AS McLaughlin JR Baker JP Johnston N Whittaker S Mendelson RA Jeejeebhoy KN What is subjective global assessment of nutritional status? 1987. Classical article Nutr Hosp 2008 23 4 400 407 18702178
- Malnutrition Advisory Group A consistent and reliable tool for malnutrition screening Nurs Times 2003 99 46 26 27 14666817
- Kruizenga HM Seidell JC de Vet HC Wierdsma NJ van Bokhorst-de van derSchueren MA Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ) Clin Nutr 2005 24 1 75 82 10.1016/j.clnu.2004.07.015 15681104 · DOI
- Ferguson M Capra S Bauer J Banks M Development of a valid and reliable malnutrition screening tool for adult acute hospital patients Nutrition 1999 15 6 458 464 10.1016/S0899-9007(99)00084-2 10378201 · DOI
- Lim SL Tong CY Ang E Lee EJ Loke WC Chen Y Ferguson M Daniels L Development and validation of 3-Minute Nutrition Screening (3-MinNS) tool for acute hospital patients in Singapore Asia Pac J Clin Nutr 2009 18 3 395 403 19786388
- Anthony PS Nutrition screening tools for hospitalized patients Nutr Clin Pract 2008 23 4 373 382 10.1177/0884533608321130 18682588 · DOI
- Alberda C Gramlich L Jones NE Jeejeebhoy K Day A Dhaliwal R Heyland DK The relationship between nutritional intake and clinical outcomes in critically ill patients: Results of an international multicenter observation study Intensive Care Med 2009 35 10 1728 1737 10.1007/s00134-009-1567-4 19572118 · DOI · Paper page
- Jensen GL Mirtallo J Compher C Dhaliwal R Forbes A Grijalba RF Hardy G Kondrup J Labadarios D Nyulasi I Castillo Pineda JC Waitzberg D International Consensus Guideline Committee Adult starvation and disease-related malnutrition: A proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee Clinical Nutrition JPEN J Parenter Enteral Nutr 2010 34 2 156 159 10.1177/0148607110361910 20375423 · DOI · Paper page
- Knaus WA Draper EA Wagner DP Zimmerman JE Apache II: a severity of diseases classification system Crit Care Med 1985 13 818 829 10.1097/00003246-198510000-00009 3928249 · DOI
- Moreno R Vincent JL Matos R Mendonca A Cantraine F Thijs L Takala J Sprung C Antonelli M Bruining H Willatts S The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicenter, study Intensive Care Med 1999 25 686 696 10.1007/s001340050931 10470572 · DOI
- Kutsogiannis J Alberda C Gramlich L Cahill N Day A Dhaliwal R Heyland D Early use of supplemental parenteral nutrition in critically ill patients: Results of an International Multicenter Observational Study Crit Care 2011 in press 21765355
- Steyerberg EW Clinical Prediction Models: A Practical Approach to Development, Validation and Updating\ 2009 New York: Springer
- Harrell FE Regression Modeling Strategies: With Application to Linear Models, Logistic Regression and Survival Analysis\ 2001 New York: Springer-Verlag
- Royston R Sauerbrei W Multivariable Model-building: A pragmatic approach to regression analysis based on fractional polynomials for modelling continuous variables\ 2008 Chichester UK: John Wiley & Sons. Ltd
- Sauerbrei W Meier-Hirmer C Benner A Royston P Multivariable regression model building by fractional polynomials: Description of SAS, STATA and R programs Computational Statistics & Data Analysis 2006 50 3464 3485 10.1016/j.csda.2005.07.015 · DOI
- Nagelkerke NJD A note on a general definition of the coefficient of determination biometrika 1991 78 691 692 10.1093/biomet/78.3.691 · DOI · Paper page
- Huang YC Yen CE Cheng CH Jih KS Kan MN Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support Clin Nutr 2000 19 2 101 107 10.1054/clnu.1999.0077 10867727 · DOI
- Schindler K Pernicka E Laviano A Howard P Schütz T Bauer P Grecu I Jonkers C Kondrup J Ljungqvist O Mouhieddine M Pichard C Singer P Schneider S Schuh C Hiesmayr M Nutrition Day Audit Team How nutritional risk is assessed and managed in European hospitals: a survey of 21,007 patients findings from the 2007-2008 cross-sectional Nutrition Day survey Clin Nutr 2010 29 5 552 559 10.1016/j.clnu.2010.04.001 20434820 · DOI
- Heyland DK Cahill NE Dhaliwal R Wang M Day AG Alenzi A Aris F Muscedere J Drover JW McClave SA Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol Crit Care 2010 14 2 R78 10.1186/cc8991 20429886 PMC2887201 · DOI
- Wischmeyer PE Heyland DK The future of critical care nutrition therapy Crit Care Clin 2010 226 3 433 441 20643297
- Murray MJ Marsh HM Wochos DN Moxness KE Offord KP Callaway CW Nutritional assessment of intensive-care unit patients Mayo Clin Proc 1988 63 11 1106 1115 3193819
Cited by
Sorted by citations
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476 · see citing works
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
Heyland, D. K., Patel, J., Compher, C., Rice, T. W., Bear, D. E., Lee, Z.-Y., González, V. C., O'Reilly, K., Regala, R., Wedemire, C., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(22)02469-2 · Cited by 401 · see citing works
Self-citationMalnutrition Screening and Assessment
Serón-Arbeloa, C., Labarta-Monzón, L., Puzo-Foncillas, J., Mallor-Bonet, T., Lafita-López, A., Bueno-Vidales, N., & Montoro-Huguet, M. (2022) · doi:10.20944/preprints202205.0071.v1 · Cited by 312
Compher, C., Chittams, J., Sammarco, T., Nicolo, M., & Heyland, D. K. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002083 · Cited by 264 · see citing works
Self-citationProtein Requirements in the Critically Ill: A Randomized Controlled Trial Using Parenteral Nutrition
Ferrie, S., Allman‐Farinelli, M., Daley, M., & Smith, K. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115618449 · Cited by 250 · see citing works
A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice
Preiser, J.-C., Arabi, Y. M., Berger, M. M., Casaer, M., McClave, S., Montejo-González, J. C., Peake, S., Reintam Blaser, A., Van den Berghe, G., van Zanten, A., et al. (2021) · Critical Care · doi:10.1186/s13054-021-03847-4 · Cited by 166 · see citing works
Wischmeyer, P. E., Hasselmann, M., Kummerlen, C., Kozar, R., Kutsogiannis, D. J., Karvellas, C. J., Besecker, B., Evans, D. K., Preiser, J.-C., Gramlich, L., et al. (2017) · Critical Care · doi:10.1186/s13054-017-1736-8 · Cited by 153 · see citing works
Self-citationArabi, Y. M., Aldawood, A. S., Al-Dorzi, H. M., Tamim, H. M., Haddad, S. H., Jones, G., McIntyre, L., Solaiman, O., Sakkijha, M. H., Sadat, M., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201605-1012oc · Cited by 153 · see citing works
Nutrition in Sepsis: A Bench-to-Bedside Review.
De Waele, E., Malbrain, M. L. N. G., & Spapen, H. (2020) · Nutrients · doi:10.3390/nu12020395 · Cited by 140 · see citing works
Stoppe, C., Goetzenich, A., Whitman, G., Ohkuma, R., Brown, T., Hatzakorzian, R., Kristof, A., Meybohm, P., Mechanick, J., Evans, A., et al. (2017) · Critical Care · doi:10.1186/s13054-017-1690-5 · Cited by 138 · see citing works
Self-citationTailoring nutrition therapy to illness and recovery
Wischmeyer, P. E. (2017) · Critical Care · doi:10.1186/s13054-017-1906-8 · Cited by 131 · see citing works
Eslamian, G., Ardehali, S. H., Baghestani, A.-R., & Vahdat Shariatpanahi, Z. (2019) · Nutrition · doi:10.1016/j.nut.2018.10.013 · Cited by 44 · see citing works
Gonzalez‐Granda, A., Schollenberger, A., Haap, M., Riessen, R., & Bischoff, S. C. (2019) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1450 · Cited by 40 · see citing works
Er, B., Simsek, M., Yildirim, M., Halacli, B., Ocal, S., Ersoy, E. O., Demir, A. U., & Topeli, A. (2021) · Respiratory Medicine · doi:10.1016/j.rmed.2021.106503 · Cited by 24 · see citing works
Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Tsai, Y.-C., Yin, C.-H., Chen, J.-S., Chen, Y.-S., Huang, S.-C., & Chen, J.-K. (2024) · Journal of Microbiology, Immunology and Infection · doi:10.1016/j.jmii.2023.12.007 · Cited by 9 · see citing works
Wang, C.-Y., Wang, T.-J., Wu, Y.-C., & Hsu, C.-Y. (2024) · Acute and Critical Care · doi:10.4266/acc.2024.00843 · Cited by 2 · see citing works
- Authors
- Heyland, D. K., Dhaliwal, R., Jiang, X., & Day, A. G.
- Affiliations
- Kingston General Hospital (CA)
- Corresponding author
- Heyland, Daren K
- Venue
- Critical Care
- Published
- 2011-11-15
- Volume
- 15
- Issue
- 6
- Pages
- R268-R268
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC3388687
- OpenAlex
- W2100342289
- Cited by
- 863
- References
- 2
- Citations by year
- 2026: 61 · 2025: 71 · 2024: 71 · 2023: 86 · 2022: 76 · 2021: 66 · 2020: 113 · 2019: 70 · 2018: 67 · 2017: 51 · 2016: 43 · 2015: 39 · 2014: 25 · 2013: 15 · 2012: 6
- FWCI
- 13.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- nutritional risk assessment, intensive care unit, critically ill patients, nutritional therapy, risk scoring tool, 28-day mortality, nutritional adequacy, interleukin-6, procalcitonin, C-reactive protein, mechanical ventilation duration, APACHE II score, SOFA score, comorbidities
- MeSH terms
- Aged, C-Reactive Protein, Calcitonin, Eating, Female, Humans, Length of Stay, Male, Middle Aged, Nutritional Status, Prospective Studies, Protein Precursors, Weight Loss, Nutrition Assessment, Calcitonin Gene-Related Peptide, Interleukin-6, Body Mass Index, Chi-Square Distribution, Logistic Models, Critical Illness, Risk Assessment, Statistics, Nonparametric, APACHE, Nutrition Therapy
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