Relationship between mNUTRIC score and 28-day mortality risk in ICU patients with sepsis
ZHENG Junqing
HAN Mengchen
TIAN Suochen
CAO Dongming
Abstract：Objective To analyze the relationship between the modified Nutrition Risk in the Critically Ill(mNU-TRIC)score and the risk of 28-day mortality after ICU admission in patients with sepsis.Methods A total of 1,051 ICU patients with a diagnosis of sepsis from the Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ)database(2009-2022)were selected.These patients were admitted to the ICU for the first time and were divided into the survival group(n=862)and non-survival group(n=189)based on 28-day mortality.Covariates previously indicated to be associated with sep-sis mortality were extracted,including demographic variables,comorbidities,disease severity scores,therapeutic inter-ventions,and laboratory results.The mNUTRIC score was calculated for both groups.Variables showing statistically sig-nificant differences in univariate analysis were treated as confounders and included in a multivariate Logistic regression model to analyze the association between the mNUTRIC score and 28-day mortality after adjusting for these confounders.A restricted cubic splines(RCS)model was used to analyze the relationship between the mNUTRIC score and the risk of 28-day mortality.A piecewise Logistic regression model was employed for breakpoint analysis to identify the risk threshold,examining the threshold effect of the mNUTRIC score on 28-day mortality risk.Results The mNUTRIC score was signifi-cantly higher in the non-survival group(5.01±1.85)than in the survival group(3.91±1.96)(P<0.05).The non-sur-vival group had significantly higher age,Sequential Organ Failure Assessment(SOFA)score,Acute Physiology Score Ⅲ(APS Ⅲ),Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,white blood cell count,neutrophil count,anion gap,lactate,aspartate aminotransferase,creatinine,blood urea nitrogen,and proportions of hypertension and myocardial infarction(all P<0.05).Conversely,albumin level,lymphocyte count,total cholesterol,hemoglobin,red blood cell count,and proportions of malignancies,chronic bronchitis,coronary heart disease,and chronic obstructive pulmonary disease were significantly lower in the non-survival group(all P<0.05).The mNUTRIC score showed a positive correlation with the risk of 28-day mortality after ICU admission[OR(95％CI)=1.26(1.13-1.39),P<0.05].The re-lationship between the mNUTRIC score and the risk of 28-day mortality exhibited an S-shaped nonlinear pattern(P<0.05).The risk threshold for the mNUTRIC score regarding 28-day mortality risk was 5.86.When the mNUTRIC score was≤5.86,each 1-point increase in the score was associated with a 40％increase in the risk of 28-day mortality.When the mNUTRIC score was>5.86,each 1-point increase was associated with a 4％increase in the risk of 28-day mortality.Conclusions The mNUTRIC score is positively and nonlinearly associated with the risk of 28-day mortality after ICU ad-mission in patients with sepsis,demonstrating an S-shaped curve.The risk threshold for the mNUTRIC score is 5.86.The mortality risk increases steeply when the score is below or equal to this threshold,while the increase in mortality risk is more gradual when the score exceeds it.
Keywords：sepsismalnutritionmodified Nutrition Risk in the Critically Ill scorerisk threshold
Publication Date：2026-01-25
Online Publishing Date：2026-03-05(First online date of this platform, not the publication date of the document)
Pages：5( 104-108 )