Prognostic Value of Nutritional Risk Scores in Septic ICU Patients: A Survival Analysis Using mNUTRIC, PNI, and CONUT

Background: Malnutrition is highly prevalent among critically ill patients and has been associated with worse clinical outcomes, particularly in sepsis. Several nutritional risk scores have been proposed to identify patients at increased risk of mortality in the intensive care unit (ICU). This study aimed to evaluate the prognostic value of three commonly used nutritional indices-modified Nutrition Risk in the Critically Ill (mNUTRIC), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT)-for predicting mortality in septic ICU patients. Methods: In this prospective observational cohort study conducted at two ICUs, 155 critically ill patients at nutritional risk were evaluated, including 105 patients with sepsis and 50 without sepsis. The primary endpoint was ICU mortality. Nutritional risk scores (mNUTRIC, PNI, and CONUT) were calculated at ICU admission. Survival analysis was performed using Kaplan-Meier (KM) curves and log-rank tests to compare survival probabilities across nutritional risk categories. Cox proportional hazards regression analysis was used to assess the association between nutritional scores and ICU mortality. Of note, only 24 mortality events were recorded in the septic cohort, which limits the statistical power of the findings. Results: KM analysis revealed significantly reduced survival among patients with severe malnutrition, as measured by the PNI score (log-rank p = 0.044). Patients with high mNUTRIC scores showed a tendency toward lower survival probability compared with those with low nutritional risk, approaching statistical significance (log-rank p = 0.059). No significant survival differences were observed between CONUT categories (log-rank p = 0.380). In univariate Cox regression analysis, the mNUTRIC score was significantly associated with ICU mortality (HR 1.67, 95% CI 1.17-2.38, p = 0.005). Conclusions: In this selected cohort, mNUTRIC demonstrated the strongest univariate prognostic signal for ICU mortality; however, this association was attenuated and did not reach statistical significance after limited multivariable adjustment. These findings are exploratory and apply specifically to a cohort of septic ICU patients with confirmed nutritional risk and therefore should not be generalized to the broader population of critically ill septic patients.