Association of the Modified Nutric Score with Mortality in Critically ill patients with COVID-19 in 3 Intensive Care Units in Guayaquil

ABSTRACT

Background: Several international guidelines have highlighted the importance of ensuring the energy and protein intake of people with COVID- 19, but little is known about the nutritional risks for patients in critical conditions. There is still controversy if the modified Nutric score (mNUTRIC) is associated with higher mortality in patients with COVID-19 in the intensive care unit (ICU). Therefore, this study aims to investigate the applicability of the mNUTRIC score to assess nutritional risks and mortality in these critically ill patients with COVID-19 to improve prognosis and clinical results. Methods: This is a retrospective, observational study carried out in three ICU specially equipped for COVID-19 at the Hospital Clinica San Francisco, Guayaquil, Ecuador. Critically ill COVID-19 patients admitted in these ICUs between March and May 2020 were the study population. The exclusion criteria were those under 18 years of age or with a length of stay in the ICU of less than 24 hours. The nutritional risk of each patient was assessed upon admission to the ICU using the mNUTRIC score, and a score ≥of 5 indicates a high nutritional risk. Mortality was calculated according to the results of the patients after 30 days of ICU hospitalization. The results were presented by descriptive statistical analysis. Results: A total of 97 COVID-19 patients were admitted to the ICU with a median age of 64 years, 68 men (70%). Based on the mNutric score at ICU admission, a low nutritional risk (< 4 points) was observed in 65% of critically ill patients with COVID-19, while a high nutritional risk (≥5 points) was observed in 34%. The ICU mortality at 30 days was significantly higher in the high nutritional risk group than the survivors (40% vs. 15%) Also this group was associated with more days in mechanical ventilation (median 11 days) and more days in ICU w(mean 13 days). Furthermore, it was observed that the patients who survived the ICU had a much higher nutritional risk than those who did not survive (84% vs 59%). Conclusion: A large percentage of critically ill COVID-19 patients were at low nutritional risk, as evidenced by the mNUTRIC score. However, patients at high nutritional risk at ICU admission showed significantly higher ICU mortality at 30 days than those who survived. Therefore, the mNUTRIC score may be an appropriate tool for assessing nutritional risk and prognosis for critically ill COVID-19 patients.