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Prognostic value of different cut-off points of the NRS-2002 tool to identify nutritional risk in critically ill patients: a longitudinal study

Published online by Cambridge University Press:  17 February 2023

Bruna Barbosa Stello ,
Aline Cattani Open the ORCID record for Aline Cattani [Opens in a new window] ,
Danielle Silla Jobim Milanez ,
Elisa Loch Razzera ,
Júlia Lima Open the ORCID record for Júlia Lima [Opens in a new window]  and
Flávia Moraes Silva
Bruna Barbosa Stello
Affiliation:
Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
Aline Cattani
Affiliation:
Nutrition and Dietetics Coordination Service of Pompeia Hospital, Caxias do Sul, Rio Grande do Sul, Brazil
Danielle Silla Jobim Milanez
Affiliation:
Nutrition Sciences Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
Elisa Loch Razzera
Affiliation:
Nutrition Sciences Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
Júlia Lima
Affiliation:
Nutrition Sciences Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
Flávia Moraes Silva*
Affiliation:
Nutrition Department and Nutrition Sciences Graduate Program of Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
*
*Corresponding author: Flávia Moraes Silva, email flaviams@ufcspa.edu.br
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Abstract

The American Society of Parenteral and Enteral Nutrition recommends nutritional risk (NR) screening in critically ill patients with Nutritional Risk Screening – 2002 (NRS-2002) ≥ 3 as NR and ≥ 5 as high NR. The present study evaluated the predictive validity of different NRS-2002 cut-off points in intensive care unit (ICU). A prospective cohort study was conducted with adult patients who were screened using the NRS-2002. Hospital and ICU length of stay (LOS), hospital and ICU mortality, and ICU readmission were evaluated as outcomes. Logistic and Cox regression analyses were performed to evaluate the prognostic value of NRS-2002, and a receiver operating characteristic curve was constructed to determine the best cut-off point for NRS-2002. 374 patients (61·9 ± 14·3 years, 51·1 % males) were included in the study. Of these, 13·1 % were classified as without NR, 48·9 % and 38·0 % were classified as NR and high NR, respectively. An NRS-2002 score of ≥ 5 was associated with prolonged hospital LOS. The best cut-off point for NRS-2002 was a score ≥ 4, which was associated with prolonged hospital LOS (OR = 2·13; 95 % CI: 1·39, 3·28), ICU readmission (OR = 2·44; 95 % CI: 1·14, 5·22), ICU (HR = 2·91; 95 % CI: 1·47, 5·78) and hospital mortality (HR = 2·01; 95 % CI: 1·24, 3·25), but not with ICU prolonged LOS (P = 0·688). NRS-2002 ≥ 4 presented the most satisfactory predictive validity and should be considered in the ICU setting. Future studies should confirm the cut-off point and its validity in predicting nutrition therapy interaction with outcomes.

Keywords

Nutritional riskIntensive careCut-off pointMortalityPrognostic
Type
Research Article
Information
British Journal of Nutrition , Volume 130 , Issue 8 , 28 October 2023 , pp. 1357 - 1365
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Nutrition Society

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