This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Not every critically ill patient benefits equally from aggressive nutrition support. The NUTRIC score (Nutrition Risk in the Critically Ill), developed by Daren Heyland and colleagues in 2011, identifies those most likely to benefit. Because interleukin-6 is rarely measured, Rahman and colleagues validated a modified NUTRIC score (mNUTRIC) without it in 2016.
The points
| Variable | Values and points |
|---|---|
| Age | under 50: 0; 50 to 74: 1; 75 or more: 2 |
| APACHE II | under 15: 0; 15 to 19: 1; 20 to 27: 2; 28 or more: 3 |
| SOFA | under 6: 0; 6 to 9: 1; 10 or more: 2 |
| Comorbidities | 0 to 1: 0; 2 or more: 1 |
| Days from hospital to ICU admission | 0: 0; 1 or more: 1 |
The modified score ranges from 0 to 9. APACHE II and SOFA are those of the day of ICU admission.
Example
A 65-year-old (1) admitted to the ICU the day after hospital admission (1), with an APACHE II of 18 (1), a SOFA of 7 (1) and two comorbidities (1), scores 5: high nutrition risk.
Interpretation
| mNUTRIC | Nutrition risk |
|---|---|
| 0 to 4 | low |
| 5 to 9 | high |
In the validation studies, high-risk patients who received more of their prescribed calories and protein had lower mortality, while low-risk patients showed little difference. The 2016 ASPEN and SCCM guidelines recommend assessing nutrition risk with NUTRIC or NRS-2002, and starting early enteral nutrition, advancing toward targets within the first week, in high-risk patients.
How nutrition targets are set
Energy needs are best measured by indirect calorimetry; otherwise 20 to 25 kcal per kg of body weight per day is a common estimate. Protein targets are usually 1.2 to 2 g per kg per day. Guidelines advise against overfeeding in the first days, especially in unstable patients.
Limits
The score was derived in mixed ICU populations and depends on how comorbidities are counted. It describes the expected benefit of nutrition but does not measure malnutrition itself, which should still be assessed with tools such as weight loss, intake history, muscle mass and the GLIM criteria.