Screening the nutritional risk in critically ill patients: development and validation of a new...

In intensive care units (ICU), malnutrition is very common and closely related to severe inflam-matory states. The aim of this study was to develop and validate a nutritional inflammatory prognostic score (NIPS) predictive of short-term mortality, and to verify the validity of existing scores. A total of 606 ICU patients were included in a longitudinal study. The population was randomly divided into two groups: development (383) and validation (223). The NIPS score was developed from nutritional and inflammatory parameters using multi-adjusted Cox proportional regression. Validation of NIPS as a prognostic score was tested using the area under the ROC curve (AUC), Cox proportional regression, and the Kaplan-Meier curve. The validity of five selected scores was also assessed. The NIPS score was developed from C-reactive protein to prealbumin ratio, total cholesterol, procalcitonin and neutrophil to lymphocyte ratio. With an AUC of 0.89 and a cutoff of 5.0, NIPS predicted short-term mortality with a sensitivity of 80.5% and a specificity of 93.8%. The risk of mortality was fivefold higher in the high nutritional risk group (RR= 5.0, [3.1-7.9], p < 0.0001). The crude cumulative incidence of mortality was significantly higher in the high-risk group (pLog-Rank < 0.0001). The five selected scores had a significant, but, lower prognostic value, compared with the developed score (AUC between 0.59 and 0.70). This study provides a new nutritional risk score, based on widely available biological parameters, with proven efficiency in predicting ICU mortality risk. Nutritional risk screening should be routinely performed at the earliest admission stages.