Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Nutrition Risk in the Critically Ill (NUTRIC) score is a tool used to estimate the risk of 28-day mortality in critically ill patients by assessing various clinical factors. This score is computed by considering six key parameters, each contributing a specific value to the total score. The higher the total, the greater the patient's risk of mortality.

Here are the inputs and their corresponding scores:

- Age, years:
  - "< 50": 0 points
  - "50-74": 1 point
  - ">= 75": 2 points

- APACHE II score:
  - "< 15": 0 points
  - "15-19": 1 point
  - "20-27": 2 points
  - ">= 28": 3 points

- SOFA score:
  - "< 6": 0 points
  - "6-9": 1 point
  - ">= 10": 2 points

- Number of comorbidities:
  - "0-1": 1 point
  - ">= 2": 1 point

- Days from hospital to ICU admission:
  - "0": 0 points
  - ">= 1": 1 point

- IL-6, mc/mL:
  - "0-399": 0 points
  - ">= 400": 1 point

To calculate the NUTRIC score, assign points to each input based on the above categories and sum these points. The total score can range from 1 to 10, with each score indicating a different risk of 28-day mortality:

- Score 0: 1% risk of mortality
- Score 1: 2% risk of mortality
- Score 2: 3% risk of mortality
- Score 3: 8% risk of mortality
- Score 4: 11% risk of mortality
- Score 5: 20% risk of mortality
- Score 6: 30% risk of mortality
- Score 7: 45% risk of mortality
- Score 8: 58% risk of mortality
- Score 9: 70% risk of mortality
- Score 10: 80% risk of mortality

Each score provides a clear prediction of the patient’s likelihood of mortality within 28 days, helping guide critical care decisions.

The Nutrition Risk in the Critically Ill (NUTRIC) score is a clinical calculator used to assess the nutritional risk and predict the outcomes of critically ill patients, particularly those in the intensive care unit (ICU). This scoring system is designed to help clinicians identify patients who would benefit most from aggressive nutritional support. The NUTRIC score includes factors such as age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, number of comorbidities, and days from hospital to ICU admission. It does not require subjective assessments of nutritional status, making it particularly useful in the ICU setting. There are no specific exclusion criteria for its use, but it is most applicable to patients who are critically ill and at high risk of malnutrition.

Nutrition Risk in the Critically Ill (NUTRIC) score

The Nutrition Risk Screening 2002 (NRS 2002) tool evaluates an individual's nutritional risk by considering four critical input factors: initial screening criteria, nutritional impairment, severity of disease, and age. Each factor's response corresponds to a predefined score that contributes to the overall risk assessment, guiding the necessary nutritional interventions.

Here's how the scoring works:

- **Initial Screening**: All options under this category result in a score of 10, whether the criterion is a body mass index under 20.5 kg/m², recent weight loss, reduced dietary intake, or being in an intensive care unit.

- **Nutritional Impairment**:
  - "None" scores 0.
  - "Weight loss > 5% in 3 months or food intake < 50-75% of normal in the past week" scores 1.
  - "Weight loss > 5% in 2 months or body mass index 18.5-20.5 kg/m² with impaired general condition or food intake 25-60% of normal in the past week" scores 2.
  - "Weight loss > 5% in 1 month or > 15% in 3 months, or body mass index < 18.5 kg/m² with impaired general condition or food intake 0-25% of normal in the past week" scores 3.

- **Severity of Disease**:
  - "Normal nutritional requirement" scores 0.
  - "Conditions like hip fracture, chronic illnesses with potential acute complications, chronic dialysis, diabetes, or cancer" score 1.
  - "Major abdominal surgery, stroke, severe pneumonia, hematologic malignancy" score 2.
  - "Head injury, bone marrow transplant, or intensive care unit patient with APACHE > 10" score 3.

- **Age**:
  - "< 70 years" scores 0.
  - ">= 70 years" scores 1.

The total score is calculated by summing the scores from each category. This cumulative score corresponds to specific nutritional risk categories with different interpretations and recommendations.

Interpretation of Scores:
- Scores up to 7 indicate a "Low risk."
- Scores of 10, 20, 30, and 40 suggest "Low risk" with a recommendation for weekly re-screening.
- Scores of 11, 21, 31, and 41 represent "Low risk" with weekly re-screening advised.
- Scores of 12, 22, 32, and 42 continue to denote "Low risk" prompting weekly review.
- Scores of 13, 23, 33, and 43 keep the individual in the "Low risk" category with a need for weekly assessment.
- Scores of 14, 24, 34, and 44 indicate the individual is "At risk," necessitating a tailored nutritional care plan involving food, oral supplements, tube feeding, or parenteral nutrition as suitable.
- Scores of 15, 25, 35, and 45 represent "High risk," prompting the initiation of an early nutritional care plan.
- Scores of 16, 26, 36, and 46 suggest "High risk," warranting immediate nutritional intervention.
- Scores of 17, 27, 37, and 47 indicate "High risk," requiring prompt implementation of a nutritional care plan.

The Nutrition Risk Screening 2002 (NRS 2002) is a clinical calculator used to assess the risk of malnutrition in hospitalized adult patients. It is particularly useful in identifying patients who may benefit from nutritional intervention, thereby improving their clinical outcomes and reducing hospital stay. The NRS 2002 takes into account factors such as age, body mass index, weight loss, dietary intake, and severity of disease. It is not recommended for use in children, pregnant women, or patients with certain conditions such as edema or ascites, which can affect weight and therefore skew the results.

Nutrition Risk Screening 2002 (NRS 2002)

Parenteral nutrition

Critically ill patients

Critically ill patients (glutamine)

Initial assessment

Peripheral parenteral nutrition

Peripheral PN

Policies and protocols

Critically ill patients, nutritional requirements

Palliative care patients

Critically ill patients, lipid injectable emulsions

Non-nutrient medications

Patients with acute pancreatitis

Pediatric patients

Pediatric patients (indications)

Patients with chronic liver disease

Choice of vascular access device

Perioperative parenteral nutrition

Perioperative PN

Home parenteral nutrition

Home PN (requirements before initiation)

Nutrition formulations

Nutrition formulations (choice of formulation)

Patients with acute kidney injury

Patients with AKI

Home PN (nutrition formulations)

Home PN (monitoring)

Patients with inflammatory bowel disease

Patients with IBD

Nutrition formulations (storing and repackaging)

Critically ill patients, indications

Preterm infants

Home PN, choice of vascular access devices

Body composition assessment

Home PN (policies and protocols)

Home PN, maintenance of vascular access devices

Healthcare professional training

Pediatric patients (management of liver disease)

Neonatal patients

Neonatal patients (calcium and phosphorus intake)

Patients with chronic kidney disease

Patients with CKD

Neonatal patients, indications

Pediatric patients (prevention of liver disease)

Monitoring and discontinuation

Home PN, indications

Indications for initiation

Parenteral nutrition

Guidelines

Key sources