Up to half of patients in the ICU are malnourished, and clinical practice guidelines suggest that all critically ill patients who stay in ICU for more than 24 hours should be regarded as at high risk for malnutrition. In order to identify and track patients with nutritional risk, nutritional assessment is essential. Various assessment tools and scoring systems are available, but only the NUTRIC score is validated for use in critically ill patients. The challenge in ICU patients is that the dietary and weight parameters typically included in nutrition screening and assessment tools are difficult to verify in ICU patients, while anthropometry measures are heavily distorted by fluid balance, oedema and body compartment changes are hard to detect. Additionally, traditional tools often don’t include evaluation of inflammation and the hypermetabolic state typical of critical illness. Clinical practice has also demonstrated that sub-groups of critically ill patients respond differently and not always consistently to nutritional interventions . The NUTRIC Score developed and validated by the Canadian group led by Daren Heyland, identifies patients who will most benefit from medical nutrition therapy by linking clinical outcomes together with poor nutrition and inflammatory markers. The original NUTRIC score scored risk out of 10 including interleukin-6 score. However, since IL-6 is frequently not available in the clinic, a modified version scored out of 9 excluding the IL-level is also validated for use.
Below is the scoring outline for the NUTRIC score. Alternatively an online NUTRIC calculator can be accessed here.
Can’t find the APACHE or SOFA score in the clinical notes? Calculate them yourself like this:
Calculate the GCS
The SOFA score predicts mortality based on severity of organ dysfunction in 6 organ systems. The score is based on worst parameters from the preceding 24 hours and therefore needs to be recalculated daily. Note that the neurological score in sedated patients corresponds to the presumed GCS a patient would score without medications. This is how to score the SOFA points.