Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool
Citations
2,947 citations
Cites background from "Identifying critically ill patients..."
...Two prospective nonrandomized studies show that patients at high nutrition risk are more likely to benefit from early EN with improved outcome (reduced nosocomial infection, total complications, and mortality) than patients at low nutrition risk.(13,18) While widespread use and supportive evidence are somewhat lacking to date, improvement in these scoring systems may increase their applicability in the future by providing guidance as to the role of EN and PN in the ICU....
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...Studies suggest that >50%–65% of goal energy may be required to prevent increases in intestinal permeability and systemic infection in burn and bone marrow transplant patients, to promote faster return of cognitive function in head injury patients, and to reduce mortality in high-risk hospitalized patients.(13,46,80,89) In a prospective nonrandomized study, Jie et al showed that high-risk surgery patients (NRS 2002 ≥5) who received sufficient preoperative nutrition therapy (>10 kcal/kg/d for 7 days) had significant reductions in nosocomial infections and overall complications compared with patients who received insufficient therapy....
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1,734 citations
Cites background from "Identifying critically ill patients..."
...Two prospective nonrandomized studies show that patients at high nutrition risk are more likely to benefit from early EN with improved outcome (reduced nosocomial infection, total complications, and mortality) than patients at low nutrition risk.(13,18) While widespread use and supportive evidence are somewhat lacking to date, improvement in these scoring systems may increase their applicability in the future by providing guidance as to the role of EN and PN in the ICU....
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...Studies suggest that >50%–65% of goal energy may be required to prevent increases in intestinal permeability and systemic infection in burn and bone marrow transplant patients, to promote faster return of cognitive function in head injury patients, and to reduce mortality in high-risk hospitalized patients.(13,46,80,89) In a prospective nonrandomized study, Jie et al showed that high-risk surgery patients (NRS 2002 ≥5) who received sufficient preoperative nutrition therapy (>10 kcal/kg/d for 7 days) had significant reductions in nosocomial infections and overall complications compared with patients who received insufficient therapy....
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1,474 citations
Cites methods from "Identifying critically ill patients..."
...The final composite NUTRIC score was correlated with mortality and the expected advantage of the score was to be able to show interaction between the score and nutritional intervention regarding outcome, hypothesizing that nutritional support might decreasemortality in patients with a high NUTRIC score (>5)....
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...Since there is no “gold standard” to define the "at risk patient" and the malnourished ICU patient, we disagree with the recent American Society for Parenteral and Enteral Nutrition (ASPEN)/ Society for Critical Care Medicine (SCCM) guidelines [41] that categorize patients according to NRS 2002 [42] or nutritional risk in critically ill (NUTRIC) [43] to define their nutritional regimen...
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...Recently, NUTRIC, a novel risk assessment tool [43] was proposed, based on age, severity of disease reflected by the APACHE II and Sequential Organ Failure (SOFA) scores, co-morbidities, days from hospital to ICU admission, and including or not inflammation assessed by the level of interleukin 6....
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...Abbreviations ALI acute lung injury ARDS adult respiratory distress syndrome ASPEN American Society for Parenteral and Enteral Nutrition BMI body mass index CI confidence interval CRP C reactive protein CT computerized tomography CVVH continuous veno-venous hemo-dia-filtration DHA docosahexaenoic acid DRI Dietary reference intakes EE energy expenditure EN enteral nutrition EPA eicosapentaenoic acid ESICM European Society of Intensive Care Medicine ESPEN European Society for Clinical Nutrition and Metabolism FA fatty acid FFMI Fat free mass index GLA gamma-linolenic acid GLN glutamine GPP good practice point HDL High density lipoprotein ICU intensive care unit IU international units K potassium LCT long chain triglyceride Mg Magnesium MCT medium chain triglyceride MNA mini-nutrition assessment MNA-SF MNA-short form MUST malnutrition universal screening tool NRS nutritional risk screening NUTRIC nutritional risk in critically ill P Phosphorus PDMS Patient data management system PICO Patient Intervention Control Outcome PN parenteral nutrition RCT randomized controlled trial REE resting energy expenditure RR relative risk SCCM Society for Critical Care Medicine SGA subjective global assessment SIGN Scottish Intercollegiate Guidelines Network SOFA Sequential Organ Failure Assessment VO2 oxygen consumption VCO2 Carbon dioxide production patient on an individual basis [5]....
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...Since there is no “gold standard” to define the "at risk patient" and the malnourished ICU patient, we disagree with the recent American Society for Parenteral and Enteral Nutrition (ASPEN)/ Society for Critical Care Medicine (SCCM) guidelines [41] that categorize patients according to NRS 2002 [42] or nutritional risk in critically ill (NUTRIC) [43] to define their nutritional regimen (discussed further)....
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308 citations
Cites background or methods from "Identifying critically ill patients..."
...Based on our observations, studies that include heterogeneous ICU patients, are more likely to be negative than those that focus on high risk patients [1,15]....
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...However, the recognition that not all ICU patients will respond the same to nutritional interventions was the critical concept behind the NUTRIC score [1,8,9]....
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...The absence of IL-6 may makes assessment of the performance of the NUTRIC score more conservative, although it is not expected that the absence of this one item will have a strong impact on the score [1]....
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...previously proposed a novel scoring tool, the Nutrition Risk in Critically ill (NUTRIC) score, which is the first nutritional risk assessment tool developed and validated specifically for intensive care unit (ICU) patients [1]....
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...All candidate predictors incorporated into our final model predictors were significantly associated with 28day mortality [1]....
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248 citations
References
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"Identifying critically ill patients..." refers methods in this paper
...Acute Physiology and Chronic Health Evaluation Scores (APACHE II) [15] and Sequential Organ Failure Assessment (SOFA) scores [16] variables were recorded on admission to ICU....
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7,264 citations
5,085 citations