A novel nutritional assessment tool combining the mNUTRIC Score and the GLIM criteria with prognostic value for in-hospital mortality in critically ill patients: a single-center retrospective cohort study

Abstract

Background: There is no gold standard tool for nutritional assessment in critically ill patients. The modified Nutrition Risk in Critically Ill (mNUTRIC) score assesses risk of future malnutrition, whereas the Global Leadership Initiative on Malnutrition (GLIM) criteria diagnose only current malnutrition.

Objectives: We aimed to evaluate the prognostic performance of a novel nutritional assessment tool that combines the mNUTRIC score and GLIM criteria for hospital outcomes among intensive care unit (ICU) patients.

Methods: A single-center, retrospective observational cohort study was conducted on patients admitted to the ICU between 1 August, 2018, and 7 June, 2021. The novel tool was categorized into 4 groups: group 1: low risk (0-4 points) by mNUTRIC plus no malnutrition from the GLIM; group 2: low risk plus moderate malnutrition or high risk (5-9 points) plus no malnutrition; group 3: high risk plus moderate malnutrition or low risk plus severe malnutrition; and group 4: high risk plus severe malnutrition.

Results: A total of 724 patients were enrolled. The in-hospital mortality rates for groups 1-4 were 3%, 16%, 32%, and 52%, respectively. A poor nutritional status by the novel nutritional assessment tool was an independent risk factor for in-hospital mortality when compared with group 1, particularly as patients progressed to group 4 (odds ratio: 2.32; 95% confidence interval: 1.84, 2.93). In the receiver operating characteristic (ROC) analysis, the novel tool demonstrated the strongest prognostic performance for in-hospital mortality (area under the ROC curve: 0.759; 95% CI: 0.723, 0.795) compared with validated severity scoring systems and other significant risk factors such as use of mechanical ventilation.

Conclusions: This novel nutritional assessment tool has strong prognostic value in being associated with in-hospital mortality. Prospective validation with an external dataset is warranted. A comprehensive nutritional assessment of the current status and future risk at ICU admission could be the most critical factor in assessing the prognosis of critically ill patients.

Keywords: critical care outcomes; critical illness; in-hospital mortality; intensive care units; malnutrition; nutritional assessment.