Introduction
Methods
Study Design and setting
Study population
Data collection
Calculation of mNUTRIC score
Outcomes
Statistical analysis
Results
Patients’ characteristics
Characteristics | Frequency | |
---|---|---|
Age (years) | Mean ± SD (range) | 61.35 ± 10.88 (28–85) |
Median (IQR) | 64 (54–70) | |
Gender | Male/Female (%) | 230/215 (51.7) |
Comorbidities | Yes (%) | 257 (57.8) |
Type of comorbidities | CHF (%) | 36 (8.1) |
DM (%) | 72 (16.2) | |
HTN (%) | 95 (21.3) | |
IHD (%) | 62 (13.9) | |
HLP (%) | 2 (0.4) | |
Others | 8 (1.8) | |
Reasons of admission | Embolism (%) | 26 (5.8) |
ARDS (%) | 16 (3.6) | |
CVA (%) | 46 (10.3) | |
EDH (%) | 15 (3.4) | |
Encephalopathy (%) | 15 (3.4) | |
ICH (%) | 35 (7.9) | |
Cancer (%) | 63 (14.2) | |
MI (%) | 20 (4.5) | |
Trauma (%) | 116 (26.1) | |
Pneumonia (%) | 27 (6.1) | |
SAH (%) | 10 (2.2) | |
Sepsis (%) | 27 (6.1) | |
Brain Tumor (%) | 15 (3.4) | |
Other (%) | 14 (3.1) | |
Type of admission | Surgery room (%) | 163 (37) |
(n = 441) | Emergency (%) | 172 (39) |
Department (%) | 88 (20) | |
Elective (%) | 18 (4) | |
APACHE II | Mean ± SD (range) | 21.07 ± 4.27 (13–35) |
Median (IQR) | 20 (18–23) | |
SOFA | Mean ± SD (range) | 10.45 ± 2.064 |
Median (IQR) | 10 (9–11) | |
Blood culture | Positive (%) | 62 (13.9) |
Nutrition characteristics and outcomes
Variables | Total patients (n = 445) | Patients with low mNUTRIC score (n = 383) | Patients with high mNUTRIC score (n = 62) | P-value | |
---|---|---|---|---|---|
Age | Mean ± SD | 61.35 ± 10.88 | 61.41 ± 11.08 | 61.02 ± 9.62 | 0.791 |
Gender | Male (%) | 230 (51.7) | 192 (50.1) | 38 (61.3) | 0.103 |
Female (%) | 215 (48.3) | 191 (49.9) | 24 (38.7) | ||
Comorbidities | Yes (%) | 257 (57.8) | 218 (56.9) | 39 (62.9) | 0.376 |
No (%) | 188 (42.2) | 165 (43.1) | 23 (37.1) | ||
APACHE II | Mean ± SD | 21.07 ± 4.27 | 19.98 ± 2.59 | 27.75 ± 6.17 | < 0.001* |
Median (IQR) | 20 (18–23) | 20 (18–22) | 29 (23–33) | ||
SOFA | Mean ± SD | 10.45 ± 2.06 | 9.95 ± 1.305 | 13.58 ± 2.97 | < 0.001* |
Median (IQR) | 10 (9–11) | 10 (9–11) | 14.5 (11–16) | ||
GVR more than | Yes (%) | 62 (13.9) | 28 (7.3) | 34 (54.8) | < 0.001* |
200 cc | No (%) | 383 (86.1) | 355 (92.7) | 28 (45.2) | |
Dysglycemia | Yes (%) | 57 (12.8) | 36 (9.4) | 21 (33.9) | < 0.001* |
No (%) | 388 (87.2) | 347 (90.6) | 41 (66.1) | ||
Type of nutrition | Enteral (%) | 385 (86.5) | 325 (91.9) | 33 (53.2) | < 0.001* |
Parenteral (%) | 52 (11.7) | 31 (8.1) | 21 (33.9) | ||
Enteral and Parenteral | 8 (1.8) | 0 | 8 (12.9) | ||
Received energy | Mean ± SD | 1636.5 ± 136.97 | 1643.94 ± 128.05 | 1591.13 ± 177.30 | 0.005* |
(Kcal) | Median (IQR) | 1650 (1600–1700) | 1650 (1600–1700) | 1600 (1500–1700) | |
Percentage of | Mean ± SD | 83.11 ± 6.54 | 84.16 ± 5.08 | 76.61 ± 9.99 | < 0.001* |
received energy | Median (IQR) | 85 (80–85) | 85 (80–85) | 75 (70–85) | |
Received Protein | Mean ± SD | 0.803 ± 0.061 | 0.811 ± 0.051 | 0.751 ± 0.086 | < 0.001* |
(gr) | Median (IQR) | 0.8 (0.8–0.85) | 0.8 (0.8–0.85) | 0.75 (0.7–0.85) | |
Percentage of | Mean ± SD | 87.57 ± 7.49 | 89.08 ± 5.71 | 78.22 ± 10.04 | < 0.001* |
received Protein | Median (IQR) | 90 (85–90) | 90 (85–90) | 75 (70–85) | |
MV | Yes (%) | 229 (51.5) | 176 (46) | 53 (85.5) | < 0.001* |
No (%) | 216 (48.5) | 207 (54) | 9 (14.5) | ||
MV duration | Mean ± SD | 6.26 ± 3.72 | 2.36 ± 3.07 | 8.55 ± 5.35 | < 0.001* |
(n = 229) | Median (IQR) | 6 (3–8) | 6 (3–8) | 9 (4–12) | |
ICU LOS | Mean ± SD | 7.38 ± 3.57 (3–21) | 6.81 ± 3.121 | 10.85 ± 4.23 | < 0.001* |
Median (IQR) | 6 (4–10) | 6 (4–10) | 11 (8–14) | ||
Hospital LOS | Mean ± SD | 11.06 ± 4.13 | 10.58 ± 3.84 | 14.03 ± 4.62 | < 0.001* |
Median (IQR) | 10 (7–14) | 10 (7–14) | 14.5 (10–18) | ||
Vasopressor | Yes (%) | 98 (22) | 50 (13.1) | 48 (77.4) | < 0.001* |
No (%) | 347 (78) | 333 (89.6) | 14 (22.6) | ||
Days of | Mean ± SD | 3.39 ± 1.78 | 0.33 ± 0.955 | 3.34 ± 2.402 | < 0.001* |
Vasopressor (n = 98) | Median (IQR) | 3 (2–4) | 3 (2–4) | 4 (1–4) | |
Mortality | Yes (%) | 38 (8.5) | 0 | 38 (61.3) | < 0.001* |
No (%) | 407 (91.5) | 383 (100) | 24 (38.7) |
Logistic regression findings
Variables | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI)
|
P
-value
|
OR (95% CI)
|
P
-value
| |
ICU length of stay | ||||
Age (> 64 vs. ≤64 years) | 1.008 (0.991–1.025) | 0.368 | 2.312 (1.375–3.887) | 0.002* |
Gender (Male vs. Female) | 1.048 (0.722–1.52) | 0.806 | 0.882 (0.549–1.415) | 0.603 |
Comorbidity (Yes vs. No) | 1.951 (1.331–2.858) | 0.001* | 1.487 (0.897–2.465) | 0.124 |
SOFA | 2.161 (1.817–2.572) | 0.001* | 2.077 (1.334–3.236) | 0.001* |
APACHE II | 1.414 (1.301–1.535) | < 0.001* | 1.008 (0.810–1.255) | 0.941 |
Blood culture (Positive vs. Negative) | 5.221 (2.694–10.116) | < 0.001* | 2.692 (1.145–6.329) | 0.023* |
mNUTRIC score (> 4 vs. ≤4) | 6.655 (3.284–13.485) | < 0.001* | 1.105 (0.370–3.302) | 0.859 |
GVR > 200 CC (Yes vs. No) | 3.803 (2.056–7.036) | < 0.001* | 2.857 (1.193–6.838) | 0.018* |
Dysglycemia (Yes vs. No) | 3.167 (8.930–4.550) | < 0.001* | 2.327 (1.298–4.910) | < 0.001* |
Hospital length of stay | ||||
Age (> 64 vs. ≤64 years) | 1.006 (0.989–1.024) | 0.460 | 1.527 (0.952–2.450) | 0.079 |
Gender (Male vs. Female) | 0.958 (0.66–1.39) | 0.821 | 0.808 (0.521–1.255) | 0.343 |
Comorbidity (Yes vs. No) | 1.994 (1.36–2.924) | < 0.001* | 1.696 (1.057–2.722) | 0.029* |
SOFA | 1.715 (1.487–1.977) | < 0.001* | 1.823 (1.196–2.780) | 0.005* |
APACHE II | 1.270 (1.187–1.359) | < 0.001* | 0.953 (0.774–1.173) | 0.647 |
Blood culture (Positive vs. Negative) | 3.844 (2.078–7.111) | < 0.001* | 1.667 (0.780–3.564) | 0.187 |
mNUTRIC score (> 4 vs. ≤4) | 3.844 (2.078–7.111) | < 0.001* | 1.191 (0.861–2.398) | 0.202 |
GVR > 200 CC (Yes vs. No) | 3.490 (1.909–6.381) | < 0.001* | 2.901 (1.299–6.481) | 0.009* |
Dysglycemia (Yes vs. No) | 3.720 (1.288–4.933) | < 0.001* | 3.935 (1.316–5.767) | 0.001* |
MV | ||||
Age (> 64 vs. ≤64 years) | 0.998 (0.981–1.015) | 0.775 | 1.022 (0.613–1.703) | 0.934 |
Gender (Male vs. Female) | 0.952 (0.656–1.381) | 0.796 | 0.760 (0.472–1.223) | 0.258 |
Comorbidity (Yes vs. No) | 1.863 (1.273–2.725) | 0.001* | 1.883 (1.129–3.140) | 0.015* |
SOFA | 2.221 (1.859–2.654) | < 0.001* | 2.466 (1.555–3.911) | < 0.001* |
APACHE II | 1.407 (1.295–1.528) | < 0.001* | 0.910 (0.726–1.140) | 0.410 |
Blood culture (Positive vs. Negative) | 8.023 (3.717–17.314) | < 0.001* | 4.036 (1.601–5.175) | 0.003* |
mNUTRIC score (> 4 vs. ≤4) | 6.92 (3.322–14.439) | < 0.001* | 1.065 (0.347–3.264) | 0.913 |
GVR > 200 CC (Yes vs. No) | 4.251 (2.233–8.09) | < 0.001* | 3.449 (1.423–8.361) | 0.006* |
Dysglycemia (Yes vs. No) | 69.59 (9.537–90.85) | < 0.001* | 3.595 (1.968–5.918) | 0.001* |
Variables | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI)
|
P
-value
|
OR (95% CI)
|
P
-value
| |
ICU Mortality | ||||
Age | 1.009 (0.978–1.041) | 0.570 | 1.238 (0.635–2.412) | 0.531 |
Gender (Male vs. Female) | 1.673 (0.841–3.325) | 0.142 | 1.669 (0.839–3.319) | 0.144 |
Comorbidity (Yes vs. No) | 2.530 (1.168–5.480) | 0.019* | 2.289 (1.006–5.211) | 0.048* |
SOFA | 7.205 (3.684–14.091) | < 0.001* | 2.518 (0.404–5.677) | 0.322 |
APACHE II | 2.570 (1.826–3.616) | < 0.001* | 1.744 (0.629–4.837) | 0.285 |
Blood culture (Positive vs. Negative) | 6.512 (3.200-13.25) | < 0.001* | 4.140 (1.806–5.492) | 0.001* |
mNUTRIC score (> 4 vs. ≤4) | 7.775 (2.097–11.957) | < 0.001* | 6.970 (1.372–8.423) | 0.019* |
GVR > 200 CC (Yes vs. No) | 5.708 (2.797–11.648) | < 0.001* | 4.317 (1.955–5.533) | 0.001* |
Dysglycemia (Yes vs. No) | 4.938 (2.377–6.257) | < 0.001* | 1.836 (0.742–4.543) | 0.189 |
MV duration | ||||
Age | 1.000 (0.981–1.019) | 0.982 | 1.934 (1.017–3.678) | 0.044* |
Gender (Male vs. Female) | 1.213 (0.802–1.833) | 0.360 | 0.970 (0.533–1.763) | 0.920 |
Comorbidity (Yes vs. No) | 1.637 (1.066–2.514) | 0.024* | 1.123 (0.583–2.165) | 0.728 |
SOFA | 3.358 (2.581–4.370) | < 0.001* | 2.823 (1.553–5.130) | 0.001* |
APACHE II | 1.691 (1.510–1.895) | < 0.001* | 1.072 (0.808–1.423) | 0.629 |
Blood culture (Positive vs. Negative) | 2.990 (1.727–5.176) | < 0.001* | 0.659 (0.268–1.624) | 0.365 |
mNUTRIC score (> 4 vs. ≤4) | 3.004 (2.265–3.984) | < 0.001* | 1.118 (0.341–3.661) | 0.854 |
GVR > 200 CC (Yes vs. No) | 3.499 (2.018–6.067) | < 0.001* | 1.683 (0.633–4.474) | 0.296 |
Dysglycemia (Yes vs. No) | 2.437 (1.399–4.175) | < 0.001* | 4.069 (3.668–5.420) | 0.001* |
Duration of vasopressor | ||||
Age | 1.011 (0.986–1.036) | 0.380 | 2.724 (1.043–4.113) | 0.041* |
Gender (Male vs. Female) | 1.698 (0.995–2.898) | 0.052 | 1.555 (0.650–3.718) | 0.321 |
Comorbidity (Yes vs. No) | 1.880 (1.073–3.295) | 0.027* | 1.056 (0.396–2.817) | 0.913 |
SOFA | 2.940 (2.259–3.827) | < 0.001* | 2.077 (0.879–4.908) | 0.096 |
APACHE II | 1.641 (1.456–1.850) | < 0.001* | 1.065 (0.698–1.626) | 0.770 |
Blood culture (Positive vs. Negative) | 6.024 (3.308–8.972) | < 0.001* | 2.423 (0.849–6.911) | 0.098 |
mNUTRIC score (> 4 vs. ≤4) | 5.626 (3.765–8.409) | < 0.001* | 5.898 (2.720–6.024) | 0.001* |
GVR > 200 CC (Yes vs. No) | 4.994 (2.737–9.113) | < 0.001* | 0.735 (0.200-2.706) | 0.644 |
Dysglycemia (Yes vs. No) | 5.541 (5.667–6.605) | < 0.001* | 4.116 (2.803–6.069) | 0.001* |
Predicting outcomes by mNUTRIC score
Outcomes | AUC (95% CI) | P-value | SN (95% CI) | SP (95% CI) | PPV (95% CI) | NPV (95% CI) | LR+ (95% CI) | LR- (95% CI) | Youden Index | Cut-point |
---|---|---|---|---|---|---|---|---|---|---|
ICU LOS (> 6 vs. ≤6 days) | 0.624 (0.577–0.669) | < 0.001* | 22.27 (17.0-28.4) | 95.56 (92.0-97.8) | 83.0 (71.8–90.4) | 55.7 (53.9–57.6) | 5.01 (2.61–9.64) | 0.81 (0.75–0.88) | 0.178 | > 4 |
Hospital LOS (> 10 vs. ≤10 days) | 0.612 (0.565–0.658) | < 0.001* | 60.73 (53.9–67.2) | 55.75 (49.0-62.3) | 57.0 (52.5–61.3) | 59.5 (54.6–64.3) | 1.37 (1.15–1.64) | 0.70 (0.58–0.86) | 0.164 | > 3 |
MV (Yes vs. No) | 0.644 (0.598–0.689) | < 0.001* | 62.45 (55.8–68.7) | 58.33 (51.5–65.0) | 61.4 (56.9–65.7) | 59.4 (54.5–64.1) | 1.50 (1.24–1.81) | 0.64 (0.53–0.79) | 0.207 | > 3 |
MV duration (≥ 6 vs. <6 days) | 0.710 (0.666–0.752) | < 0.001* | 73.23 (64.6–80.7) | 55.97 (50.3–61.5) | 39.9 (36.0-43.8) | 84.0 (79.5–87.7) | 1.66 (1.41–1.96) | 0.48 (0.35–0.65) | 0.292 | > 3 |
Vasopressor (Yes vs. No) | 0.807 (0.767–0.843) | < 0.001* | 86.73 (78.4–92.7) | 57.35 (52.0-62.6) | 36.5 (33.2–39.9) | 93.9 (90.2–96.2) | 2.03 (1.76–2.35) | 0.23 (0.14–0.39) | 0.440 | > 3 |
Duration of vasopressor (≥ 3 vs. <3 days) | 0.726 (0.680–0.769) | < 0.001* | 81.36 (69.1–90.3) | 57.35 (52.0-62.6) | 25.3 (22.2–28.7) | 94.5 (91.0-96.7) | 1.91 (1.61–2.27) | 0.33 (0.19–0.56) | 0.387 | > 3 |
Mortality (Yes vs. No) | 0.973 (0.954–0.986) | < 0.001* | 92.11 (78.6–98.3) | 94.10 (91.4–96.2) | 59.2 (49.3–68.4) | 99.2 (97.7–99.7) | 15.62 (10.4–23.2) | 0.084 (0.028–0.25) | 0.862 | > 4 |