Extending Nutritional Risk Screening in Critically Ill Patients using IoT devices
24 Feb 2018-pp 45-47
TL;DR: The objective of this study is to validate the NUTRIC score for aggressive nutrition therapy and identify critically ill patients that are most likely to benefit from macronutrients with an aim to improving mortality rate.
Abstract: The NUTRIC score (Nutrition Risk in the Critically Ill) is a method designed to calculate the risk of critically ill patients developing adverse conditions that is likely be improved by optimal nutritional therapy The objective of this study is to validate the NUTRIC score for aggressive nutrition therapy and identify critically ill patients that are most likely to benefit from macronutrients with an aim to improving mortality rate A logistic model is proposed to identify the relationship between the observed parameters of NUTRIC score like age, APACHE II score, SOFA score and number of co-morbidities using statistical methods and further authenticate it The relationship between these parameters is often aggravated in the ICU due to the hypermetabolic nature of critical illness This care can be extended by use of IoT devices which may be wearable for monitoring patients health It will help not only to keep track patient's health, but to improve how the physicians deliver care as well New technology innovations can be leveraged in nutritional health care context to monitor patients remotely
...read more
References
More filters
1,692 citations
TL;DR: This scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy in the intensive care unit (ICU), and based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI.
Abstract: To develop a scoring method for quantifying nutrition risk in the intensive care unit (ICU). A prospective, observational study of patients expected to stay > 24 hours. We collected data for key variables considered for inclusion in the score which included: age, baseline APACHE II, baseline SOFA score, number of comorbidities, days from hospital admission to ICU admission, Body Mass Index (BMI) < 20, estimated % oral intake in the week prior, weight loss in the last 3 months and serum interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) levels. Approximate quintiles of each variable were assigned points based on the strength of their association with 28 day mortality. A total of 597 patients were enrolled in this study. Based on the statistical significance in the multivariable model, the final score used all candidate variables except BMI, CRP, PCT, estimated percentage oral intake and weight loss. As the score increased, so did mortality rate and duration of mechanical ventilation. Logistic regression demonstrated that nutritional adequacy modifies the association between the score and 28 day mortality (p = 0.01). This scoring algorithm may be helpful in identifying critically ill patients most likely to benefit from aggressive nutrition therapy.
448 citations
TL;DR: In a mixed Asian ICU population, mNUTRIC score is independently associated with 28-day mortality, and higher nutritional adequacy was associated with a lower predicted 28- day mortality in patients with a high mNUTrition RIsk score.
Abstract: Summary Background & aims For patients in the intensive care unit (ICU), nutritional risk assessment is often difficult. Traditional scoring systems cannot be used for patients who are sedated or unconscious since they are unable to provide information on their history of food intake and weight loss. We aim to validate the NUTRIC (NUTrition RIsk in Critically ill) score, an ICU-specific nutrition risk assessment tool in Asian patients. Methods This was an observational study in the medical ICU of a university-affiliated tertiary hospital. We included all adult patients (≥18years) admitted between October 2013 and September 2014 who stayed for more than 24 hours in the ICU. Components of the modified NUTRIC (mNUTRIC) score, demographic details, body mass index (BMI), use of mechanical ventilation (MV), vasopressor drugs, and renal replacement therapy (RRT) were obtained from the ICU database. For patients on MV (maximum 12 days), we calculated the energy intake and nutritional adequacy (energy received ÷ energy recommended) from enteral or parenteral feeding data. Multivariable logistic regression analysis was used with 28-day mortality as the outcome of interest. Results 401 patients (62% male, mean age 60.0 ± 16.3 years, mean BMI 23.9 ± 6.2 kg/m 2 ) were included. In the univariate analysis, BMI, mNUTRIC score, MV, vasopressor drug, and RRT were associated with 28-day mortality. In the multivariable logistic regression analysis, mNUTRIC score (Odds ratio, OR 1.48, Confidence Interval, CI 1.25–1.74, p Nutritional adequacy was assessed in a subgroup of 273 (68%) patients who received MV for at least 48 hours. Median (IQR) nutritional adequacy was 0.44 (0.15–0.70). In patients with high mNUTRIC score (5–9), higher nutritional adequacy was associated with a lower predicted 28-day mortality; this was not observed in patients with low mNUTRIC (0–4) score (effect modification, p interaction Conclusion In a mixed Asian ICU population, mNUTRIC score is independently associated with 28-day mortality. Increased nutritional adequacy may reduce the 28-day mortality in patients with a high mNUTRIC score.
82 citations
TL;DR: Traditional screening and assessment tools did not uniformly identify patients as malnourished or at nutrition risk in the ICU and therefore may be inappropriate for use in this population.
Abstract: Background: Identifying patients at nutrition risk proves difficult in the intensive care unit (ICU) due to the nature of critical illness. No consensus exists on the most appropriate method to identify these patients. Traditional screens and assessments are often limited due to their subjective nature. The purpose of the quality improvement project was to compare proportions of ICU patients deemed at nutrition risk using 3 different tools. Material and Methods: A convenience sample of 294 patients admitted to the ICU was used. Patients were assessed using the institution’s routine nutrition screening method, the Subjective Global Assessment (SGA), and the NUTrition Risk in Critically ill (NUTRIC) score. Information was collected on demographics, severity of illness, hospital and ICU length of stay (LOS), and disposition. Descriptive statistics were used to examine counts/proportions of risk categories; means ± SD were used to summarize demographic and clinical variables. Results: A total of 139 patients ...
69 citations
TL;DR: Almost half of the patients in Portuguese ICUs are at high nutritional risk, and NUTRIC score was strongly associated with main clinical outcomes, including mortality from all causes at 28 days after admission.
Abstract: Purpose Characterize the nutritional risk of critically ill patients with the modified NUTrition Risk in the Critically ill (NUTRIC) score. Materials National, multicenter, prospective, observational study conducted in 15 polyvalent Portuguese intensive care unit (ICU), during 6 months. Adult patients were eligible. Those transferred from another ICU or readmitted, brain dead at admission, and with length of ICU stay (LOS) of 72 hours or less were excluded. NUTRIC score was calculated at admission; scores ≥5 represent a high nutritional risk. Main outcome was mortality from all causes at 28 days after admission to the ICU; LOS and days without mechanical ventilation (days free of MV) were secondary outcomes. Results From 2061 admissions, 1143 patients were considered, mostly males (n = 744, 64.7%) with median (P 25 -P 75 ) age of 64 (51-75). Patients at high nutritional risk were 555 (48.6%). High NUTRIC score was associated with longer LOS ( P P = .002) and higher 28-day mortality ( P Conclusions Almost half of the patients in Portuguese ICUs are at high nutritional risk. NUTRIC score was strongly associated with main clinical outcomes.
62 citations