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Prognostic Value of mNUTRIC and CONUT Scores in ICU Patients with Intracranial Hemorrhage
Mehtap Zengi1, Gülbahar Çalışkan1
1Intensive Care Unit, Department of Anesthesiology and Reanimation, Bursa City Hospital, 16250 Bursa, Turkey.
Insights
The Controlling Nutritional Status (CONUT) score independently predicts mortality in intensive care unit (ICU) patients with intracerebral hemorrhage (ICH). Both CONUT and modified Nutrition Risk in Critically Ill (mNUTRIC) scores aid in assessing ICH patient outcomes.
Area of Science:
- Neurology
- Critical Care Medicine
- Nutritional Science
Background:
- Intracerebral hemorrhage (ICH) is a severe stroke subtype with high mortality and morbidity.
- Predicting mortality in heterogeneous ICH patient populations is clinically challenging.
- Nutritional status assessment may offer prognostic insights.
Purpose of the Study:
- To evaluate the prognostic value of modified Nutrition Risk in Critically Ill (mNUTRIC) and Controlling Nutritional Status (CONUT) scores in ICU patients with ICH.
- To compare the predictive performance of nutritional scores against conventional severity scores (GCS, APACHE II, SOFA).
Main Methods:
- Retrospective cohort study of 347 ICU patients with ICH.
- Analysis of nutritional scores (mNUTRIC, CONUT) and conventional severity scores (GCS, APACHE II, SOFA).
- Multivariate logistic regression and ROC analyses to determine independent predictors and discrimination.
Main Results:
- ICU mortality was 24.2%.
- Elevated mNUTRIC and CONUT scores were associated with higher mortality.
- CONUT score was identified as an independent predictor of mortality (OR = 1.174, p = 0.040).
- ROC analysis showed good discrimination for both scores (AUC > 0.81).
Conclusions:
- Both mNUTRIC and CONUT scores are associated with mortality in ICU patients with ICH.
- The CONUT score demonstrates independent prognostic value for ICH mortality.
- Combined assessment of nutritional and severity scores may enhance clinical decision-making for ICH patients.
Abstract:
Background: Stroke is the most common neurological disorder in adults and a leading cause of mortality and disability. Intracerebral hemorrhage (ICH), although less frequent than ischemic stroke, is associated with higher morbidity and mortality and often requires ICU admission. Predicting mortality remains challenging due to disease heterogeneity. Objectives: This study evaluated the prognostic value of the modified Nutrition Risk in Critically Ill (mNUTRIC) and Controlling Nutritional Status (CONUT) scores, along with conventional severity scores (GCS, APACHE II, SOFA), in ICU patients with ICH. Methods: This retrospective cohort study included 347 ICU patients with ICH admitted between January 2019 and June 2025. Patients were stratified by survival status and nutritional and conventional severity scores were analyzed. Subgroup analysis was performed in patients with GCS ≤ 12 and APACHE II ≥ 17 (n = 96). Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed predictive performance. Results: ICU mortality was 24.2%. Deceased patients had lower GCS and higher APACHE II, SOFA, mNUTRIC, and CONUT scores (p < 0.001). Subgroup analysis showed higher mortality in patients with elevated mNUTRIC and CONUT scores (p = 0.038 and p = 0.005). Multivariate analysis identified GCS (OR = 0.675, p < 0.001) and CONUT (OR = 1.174, p = 0.040) as independent predictors; mNUTRIC was not significant. ROC analysis demonstrated good discrimination (AUC 0.818 for mNUTRIC and 0.81 for CONUT), with mNUTRIC being more specific and CONUT more sensitive. Optimal cut-off values were >3 for mNUTRIC and >4 for CONUT. Conclusions: Both mNUTRIC and CONUT scores are associated with mortality in ICU patients with ICH, with CONUT showing independent prognostic value. Their combined use may aid clinical decision-making.