Mnutric

1. GUIDE :DR UMESH RAJOOR
PROFESSOR AND HOD
DEPT OF GENERAL MEDICINE
KIMS, KOPPAL
STUDENT :DR SRINIVASA B J
POST GRADUATE
DEPT OF GENERAL MEDICINE
KIMS,KOPPAL
MODIFIED NUTRITION RISK IN CRITICALLY ILL (m
NUTRIC) SCORE , A PROGNOSTIC MARKER FOR
PREDICTING MORBIDITY AND MORTALITY IN
MECHANICALLY VENTILATED PATIENTS IN
TEACHING HOSPITAL ,KIMS, KOPPAL.

2. INTRODUCTION
1) Malnutrition is immensely prevalent, with expeditious muscle loss observed in the initial stages of the disease,
and is more usual in those with multiple organ dysfunction. Indeed, sarcopenia is exceedingly common in
patients requiring Mechanical Ventilation(MV). Malnutrition has been reported to be associated with increased
nosocomial infections, prolonged MV, extended hospitalization, frequent rehospitalization, reduced quality of life,
and greater mortality1.
2) A number of nutritional assessment tools are available for assessing the nutrition status of the patients
including anthropometric data, physical examination, history of weight loss, dietary intake, and clinical diagnosis.
Most of the nutritional screening tools available are validated in hospitalized patients; no specific tool is available
for ICU patients.
3) Nutrition Risk in Critically Ill (NUTRIC) score is the first nutritional risk assessment tool to identify high nutritional
risk patients admitted in ICUs introduced in 20112. It comprises six parameters, including age, number of
comorbidities, APACHE II score, SOFA score, number of days between hospital and ICCU admission, and blood
interleukin-6 (IL-6) levels. This scoring system helps in classifying the Critically Ill(CI) patients at either low or high
nutritional risk and simultaneously identifying the CI patients that are most likely to respond to aggressive
nutritional therapy. In 2015, IL-6 was excluded from the NUTRIC score and termed as Modified NUTRIC
(mNUTRIC) score was introduced3.

3. NUTRIC SCORE and mNUTRIC SCORE
The NUTRIC Score is designed to quantify the risk of critically ill patients developing adverse
events that may be modified by aggressive nutrition therapy. The score, of 1-10, is based on 6
variables that are explained below in Table 1. The scoring system is shown in Tables 2 and 3.
Table 1: NUTRIC Score variables
Variable Range Points
Age <50 0
50 - <75 1
>75 2
APACHE II <15 0
15 - <20 1
20-28 2
>28 3
SOFA <6 0
6 - <10 1
>10 2
Number of Co-
morbidities
0-1 0
>2 1
Days from hospital to
ICU admission
0 - <1 0
>1 1
IL-6 0 - <400 0
> 400 1
Table 2: NUTRIC Score scoring system:2
Sum of
points
Cate
gory
Explanation
6-10 High
Score
 Associated with worse clinical outcomes
(mortality, ventilation).
 These patients are the most likely to
benefit from aggressive nutrition therapy.
0-5 Low
Scor
e
 These patients have a low malnutrition risk.
Table 3; mNUTRIC SCORE scoring system3
Sum of
points
Categor
y
Explanation
5-9 High
Score
 Associated with worse clinical outcomes (mortality,
ventilation).
 These patients are the most likely to benefit
from aggressive nutrition therapy.
0-4 Low
Score
 These patients have a low malnutrition risk.

4. NEED FOR THE STUDY
Therefore, mNUTRIC score is the useful tool for predicting the morbidity and mortality of MV
patients. To best of our knowledge there are no studies conducted in this part of North
Karnataka regarding the assessing the nutrition in critical ill patients requiring MV. Hence this
study is undertaken to evaluate mNUTRIC score, a Prognostic marker for predicting the
morbidity and mortality of the MV patients. .

5. OBJECTIVES OF THE STUDY
• To assess the nutritional risk of critically ill patient requiring MV by
using mNUTRIC score.

6. REVIEW OF LITERATURE
1) Dsouza M et al , in their prospective observational study among 250 MV patients found
that The mNUTRIC score of >2 suggested high mortality among CI patients requiring MV. More
than a quarter of patients had high nutritional risk and these patients had a significantly severe
illness at admission.
2) Kalaiselvan MS et al, in their prospective observational study in 678 MV patients found
that the prevalence of nutritional risk in MV patients using mNUTRIC score was 42.5%. High
mNUTRIC score was associated with increased ICU length of stay and higher mortality.
3) Gattani s et al, in their prospective cross sectional study among 1990 patients found
that the discriminative performance of mNUTRIC scores for assessing overall mortality and the
need for mechanical ventilation was found to be effective.
4) Tseng, C.-C et al in their study found that the mNUTRIC score is a better independent factor for
predicting hospital mortality and treatment outcomes than other scoring systems. With the
mNUTRIC score cut-off value of 5.5.

7. 5) In a multicenter prospective cohort study by R. Mendes et al among 1143 patients found that
The modified NUTRIC score, the first nutritional risk assessment tool developed and validated
specifically for critically ill patients, demonstrated that in ICU Portuguese patients, despite
presenting different characteristics from the original validated sample, a good correlation with main
clinical outcomes. The modified NUTRIC score can be used widely and systematically, contributing
to discriminate ICU patients at high nutritional risk. The cross-cultural adaptation of NUTRIC score
demonstrated translation reliability and is acceptable to be used in critically ill patients
6) In Prospective Observational Study by Ata ur-Rehman H et al among 75 patients found that
According to the mNUTRIC scores, 45% of mechanically ventilated patients were at nutritional risk.
High mNUTRIC scores are directly proportional to the average length of stay in the ICU and
mortality.

8. METHODOLOGY
STUDY TYPE : Prospective observational study
SAMPLE SIZE: 200
DURATION OFTHE STUDY : 1st July 23 to 31st dec 24
STUDY CENTRE : KIMS Teaching Hospital, Koppal

9. INCLUSION CRITERIA
1) Patients aged more than 18 years admitting in MICU requiring MV
for more than 48 hours

10. • EXCLUSION CRITERIA
1) Age less than 18 years
2) Dies within 48 hours of admission
3) brain dead at admission
4) readmission to the ICU during their same hospital admission
5) Transferring from another ICU or hospital.

11. NUTRIC SCORE and mNUTRIC SCORE
The NUTRIC Score is designed to quantify the risk of critically ill patients developing adverse
events that may be modified by aggressive nutrition therapy. The score, of 1-10, is based on 6
variables that are explained below in Table 1. The scoring system is shown in Tables 2 and 3.
Table 1: NUTRIC Score variables
Variable Range Points
Age <50 0
50 - <75 1
>75 2
APACHE II <15 0
15 - <20 1
20-28 2
>28 3
SOFA <6 0
6 - <10 1
>10 2
Number of Co-
morbidities
0-1 0
>2 1
Days from hospital to
ICU admission
0 - <1 0
>1 1
IL-6 0 - <400 0
> 400 1
Table 2: NUTRIC Score scoring system:
Sum of
points
Cate
gory
Explanation
6-10 High
Score
 Associated with worse clinical outcomes
(mortality, ventilation).
 These patients are the most likely to
benefit from aggressive nutrition therapy.
0-5 Low
Scor
e
 These patients have a low malnutrition risk.
Table 3; mNUTRIC SCORE scoring system
Sum of
points
Categor
y
Explanation
5-9 High
Score
 Associated with worse clinical outcomes (mortality,
ventilation).
 These patients are the most likely to benefit
from aggressive nutrition therapy.
0-4 Low
Score
 These patients have a low malnutrition risk.
Method of collection of data:

12. REFERENCES
1. Dsouza M, Nagar VS, Radhakrishnan R, et al. Modified Nutrition Risk in Critically Ill Score, A Prognostic Marker of
Morbidity and Mortality in Mechanically Ventilated Patients: A Prospective Observational Study. J Assoc Physicians India
2022;70(11):53–56.
2. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the
development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.
3. Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most
from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr.
2016;35(1):158–62.
4. Kalaiselvan MS, Renuka MK, Arunkumar AS. Use of nutrition risk in critically ill (NUTRIC) score to assess nutritional risk in
mechanically ventilated patients: A prospective observational study. Indian J Crit Care Med 2017;21:253-6
5. Gattani S, Kumar S, Acharya S, Wanjari A, Bawankule S, Agrawal S, Talwar D. Modified nutrition risk (mNUTRIC) score in
critically ill patients: Is it a reliable predictor of outcome in the intensive care unit?, Journal of Emergency Medicine, Trauma &
Acute Care, 2022(4):26 http://doi.org/10.5339/jemtac.2022.26
6. Tseng, C.-C.; Tu, C.-Y.; Chen, C.-H.; Wang, Y.-T.; Chen, W.-C.; Fu, P.-K.; Chen, C.-M.; Lai, C.-C.; Kuo, L.-K.; Ku, S.-C.; et al.
Significance of the Modified NUTRIC Score for Predicting Clinical Outcomes in Patients with Severe CommunityAcquired
Pneumonia. Nutrients 2022, 14, 198. https://doi.org/10.3390/ nu14010198
7. Mendes, Rosa & Policarpo, Sara & Fortuna, Philip & Alves, Marta & Virella, Daniel & Heyland, Daren. (2016). Nutritional risk
assessment and cultural validation of the modified NUTRIC score in critically ill patients-A multicenter prospective cohort
study. Journal of Critical Care. 37. 10.1016/j.jcrc.2016.09.007.
8. Ata Ur-Rehman H, Ishtiaq W, Yousaf M, et al. (December 27, 2018) Modified Nutrition Risk in Critically Ill (mNUTRIC) Score
to Assess Nutritional Risk in Mechanically Ventilated Patients: A Prospective Observational Study from the Pakistani
Population. Cureus 10(12): e3786. DOI 10.7759/cureus.3786

13. THANK YOU