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Nutrition in acute and chronic diseases

Nutritional indices at admission are associated with mortality rates of patients in the intensive care unit

European Journal of Clinical Nutrition volume 76, pages 557–563 (2022)Cite this article

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Abstract

Background

Malnutrition is a common occurrence in critically ill patients, and has been related to poor prognosis in various diseases. Here, we assess the prognostic value of malnutrition using nutritional indices in intensive care units (ICU) patients.

Methods

We retrieved information on 2060 patients from the Medical Information Mart for Intensive Care III, and randomized the patients into training and validation cohorts, at a ratio of 7:3. We estimated their nutritional indices using prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) score. Both multivariate regression analysis and the Kaplan–Meier (KM) survival curve were used to examine the prognostic role of nutritional indices in ICU mortality. Then we evaluated the additional predictive significance of each nutritional index beyond the baseline model including conventional risk factors.

Results

Multivariate regression analysis revealed that PNI, GNRI, and CONUT were independent predictors of in-hospital and 1-year mortality (all P < 0.001). KM curves showed higher 1-year mortality rates in having nutritional risk patients (PNI ≤ 38 or GNRI ≤ 98 or CONUT ≥ 2). Moreover, subgroup analyses revealed a significant association between each nutritional index and 1-year mortality in patients with different comorbidities. We also observed a pronounced additional impact on the predictive value of 1-year mortality when PNI, GNRI, and CONUT were separately added to the baseline model. The additional role of each nutritional index was further verified in the validation cohort.

Conclusions

Our results revealed that the nutritional indices at admission are significantly correlated with increased mortality rates in ICU adult patients.

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Fig. 1: Kaplan–Meier curves for 1-year accumulative survival rates by PNI, GNRI and CONUT categories.
Fig. 2: Forest plot of hazard ratios for the correlation of nutritional indices and mortality in intensive care units.

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Acknowledgements

We thank Jeremiah Machuki for language editing.

Funding

Chengdu Science and Technology Agency (NO. 2020-YF05-00184-SN).

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Yue Shao

  2. Department of Cardiothoracic Surgery, Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China

    Qian-cheng Lai

  3. The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Qin Duan, Ping Ge & Liu Ye

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  1. Yue Shao
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Contributions

YS was responsible for designing protocol, conducting the search, extracting and analyzing data from MIMIC-III, interpreting results, and creating “Summary of findings” tables. Q-cL was responsible for designing the review protocol and extracting data. QD and PG contributed to updating reference lists and provided feedback on the report. LY contributed to analyzing data, interpreting results, as well as creating tables and figures, and writing paper.

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Correspondence to Liu Ye.

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Shao, Y., Lai, Qc., Duan, Q. et al. Nutritional indices at admission are associated with mortality rates of patients in the intensive care unit. Eur J Clin Nutr 76, 557–563 (2022). https://doi.org/10.1038/s41430-021-00994-3

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