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

The American Society of Parenteral and Enteral Nutrition recommends nutritional risk (NR) screening in critically ill patients with NRS-2002 ≥ 3 as NR and ≥ 5 as high NR. The present study aimed to evaluate the predictive validity of different cut-off points of the NRS-2002 in the intensive care unit (ICU). A prospective cohort study was conducted with critically ill 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 an ROC curve was constructed to determine the best cut-off point for NRS-2002. A total of 374 patients (61.9±14.3 years, 51.1% males) were included in the study. Of these, 13.1% were classified as without NR, whereas 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 admission (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). Therefore, NRS-2002 ≥ 4 presented the most satisfactory predictive validity and should be considered for NR screening in the ICU setting. Future studies should confirm the cut-off point and its validity in predicting nutrition therapy interaction with outcomes.