[Predictive value of the modified Nutrition Risk in Critically Ill Score for intensive care unit mortality risk in...

To explore the predictive value of the first modified Nutrition Risk in the Critically Ill Score (mNUTRIC) assessed within 24 hours of admission to the intensive care unit (ICU) for the risk of ICU mortality in patients with sepsis.

A single-center prospective cohort study was conducted, enrolling septic patients admitted to the department of critical care medicine, the First Affiliated Hospital of Guangxi Medical University, from November 2024 to June 2025. Basic patient information, past medical history, complications, critical care-related scores and initial laboratory parameters obtained within 24 hours of ICU admission, as well as the duration of continuous renal replacement therapy (CRRT), mechanical ventilation and physical restraint during ICU stay were collected. The mNUTRIC score was calculated for each patient. Patients were followed up to record ICU mortality and length of ICU stay. According to the mNUTRIC score, patients were divided into four groups: Q1 group (mNUTRIC score<4 points), Q2 group (4 points≤mNUTRIC score<5 points), Q3 group (5 points≤mNUTRIC score<6 points) and Q4 group (mNUTRIC score≥6 points). The above-mentioned indicators were compared among the four groups. Multivariate Cox regression analysis was used to evaluate the association between the first mNUTRIC score within 24 hours of ICU admission and ICU mortality in septic patients. Restricted cubic spline (RCS) analysis was performed to test the dose-response relationship between mNUTRIC score and ICU mortality. Receiver operator characteristic curve (ROC curve) was plotted, and the area under the curve (AUC) was calculated to assess the predictive efficacy of mNUTRIC score for ICU mortality. Patients were further stratified according to the optimal cut-off value determined by the Youden index. Kaplan-Meier survival curves were drawn to estimate the cumulative ICU survival probability of patients in the two subgroups, and the Log-rank test was used to compare the survival difference between the two groups. Subgroup analysis and interaction test were conducted to evaluate the consistency of the association between mNUTRIC score and ICU mortality across different subgroups.

A total of 335 septic patients were enrolled in this study, including 81 cases in Q1 group, 76 cases in Q2 group, 76 cases in Q3 group and 102 cases in Q4 group. The overall ICU mortality rate was 17.6% (59/335). Significant differences were observed among the four groups in terms of age, past medical history (hypertension, diabetes mellitus, coronary heart disease), complications [septic shock, acute kidney injury (AKI), multiple organ dysfunction syndrome (MODS)], Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Charlson Comorbidity Index (CCI), albumin (Alb), aspartate aminotransferase (AST), blood lactic acid (Lac), duration of CRRT and mechanical ventilation, and ICU mortality (all P<0.05). In the multivariate Cox regression model with full adjustment for confounding factors, mNUTRIC score was significantly and non-linearly positively correlated with ICU mortality. Each 1-point increase in mNUTRIC score was associated with an 89% increase in the risk of ICU mortality [hazard ratio (HR)=1.89, 95% confidence interval (95%CI) was 1.52-2.36, P<0.001]. The ROC curve analysis showed that the AUC of mNUTRIC score for predicting ICU mortality was 0.769 (95%CI was 0.711-0.828), with a Youden index of 0.424, an optimal cut-off value of 4.5 points, a sensitivity of 88.1% and a specificity of 54.3%. Based on the optimal cut-off value, the cohort was further divided into the mNUTRIC score<4.5 subgroup and the mNUTRIC score≥4.5 subgroup. The Kaplan-Meier survival curves demonstrated that the cumulative survival probability of patients in the mNUTRIC score≥4.5 subgroup was significantly lower than that in the mNUTRIC score<4.5 subgroup (Log-rank test: χ²=28.540, P<0.000 1), suggesting that mNUTRIC score≥4.5 points was associated with a higher risk of ICU mortality. In all subgroups, mNUTRIC score was robustly and positively correlated with ICU mortality (all HR>1), with no significant interaction observed (all P>0.05), indicating that the positive association between mNUTRIC score and ICU mortality risk in septic patients was consistent across different subgroups.

The mNUTRIC score has good predictive efficacy for ICU mortality risk in patients with sepsis. Timely implementation of nutritional or supportive interventions based on the mNUTRIC score may improve the adverse ICU outcomes of these patients.