Relevance of AND-ASPEN criteria of malnutrition to predict hospital mortality in critically ill patients: A prospective study

Abstract

Purpose: Malnutrition is prevalent in the intensive care units (ICU), yet, there is a paucity of validated assessment tools. Subsequently, this study evaluates the validity of the malnutrition AND-ASPEN tool as an ICU mortality predictor.

Methods: Patients admitted to a large mixed ICU (72 beds) from 2014 to 2016, were followed during stay and had electronic health records on sex, age, Apache II and baseline nutrition assessment collected at admission. Patients with shortstay (<48h) and missing data were excluded. The main hypothesis, hospital mortality prediction, was assessed with a logistic regression model.

Results: Patients eligible were 375 where 13% were excluded by the adopted criteria. In the eligible group, 94.2% had AND-ASPEN assessment in their files, showing a malnutrition prevalence rate of 29.7%. Logistic regression (n=327, p=0.0001, r²=0.304, Roc (AUC)=0.80) suggested that mortality risk was 2.5× higher (95%CI, 1.38-4.46, p=0.001) in malnourished patients vs non-malnourished (controlled by sex, Apache II, hospital stay and clinical admission), malnutrition crude OR was 3.04 (95% CI, 1.86-4.97). For every 1-point increase in Apache II, mortality risk rises 14% (95%CI 1.10-1.18, p=0.001).

Conclusion: This study showed the applicability of the AND-ASPEN tool in the ICU setting as a predictor of mortality.