Predictive value of mNUTRIC score for chronic critical illness in patients of sepsis complicated with ARDS.

Abstract

ObjectiveTo explore the predictive value of the modified NUTrition Risk in the Critically ill (mNUTRIC) for patients with sepsis and acute respiratory distress syndrome (ARDS) developing into chronic critical illness (CCI).BackgroundSepsis is an important risk factor for Acute respiratory distress syndrome (ARDS), and sepsis induced ARDS accounts for 32% of patients. Patients with this subtype of ARDS have a worse prognosis than those with sepsis alone or ARDS, usually facing higher mortality rates and lower success rates of extubation, and have received more attention in clinical practice.MethodsA retrospective observational study was conducted on 118 patients admitted to the Intensive Care Unit (ICU) of Yiwu Central Hospital from January 2020 to May 2022. Patients were categorized into two groups: CCI and rapid recovery (RAP), based on the occurrence of CCI. Age, gender, white blood cell count, C-reactive protein, albumin, serum creatinine, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mNUTRIC score, ICU length of stay, mechanical ventilation duration, and continuous renal replacement therapy (CRRT) were compared between the two groups. The association between mNUTRIC and CCI in patients with sepsis complicated by ARDS was further examined using three models and multivariate logistic regression.The receiver operating characteristic (ROC) curve was utilized to analyze the predictive values of mNUTRIC score, SOFA score, and APACHE II score for predicting the occurrence of CCI in patients with sepsis complicated by ARDS.ResultsThe age, mNUTRIC score, SOFA score, APACHE II score, ICU length of stay, mechanical ventilation duration, and CRRT ratio were significantly higher in the CCI group compared to the RAP group (all P < 0.05). Conversely, there were no statistically significant differences in white blood cell count, C-reactive protein, and albumin levels between the two groups (all P > 0.05). Multivariate logistic regression analysis identified the mNUTRIC score as an independent risk factor for CCI in patients with sepsis complicated by ARDS. The constructed models showed that the mNUTRIC score remained significant, while the SOFA score and APACHE II score did not.The area under the ROC curve analysis demonstrated that the mNUTRIC score had the highest AUC of 0.880, 95% Confidence Interval (CI): 0.808-0.933. The AUC for the SOFA score was 0.864, and for the APACHE II score was 0.825, all of which were statistically significant.ConclusionsThe mNUTRIC score is valuable in predicting the progression of sepsis combined with ARDS to CCI, and may even be superior to the SOFA score and APACHE II score.