Nutritional and physiological severity scores for predicting 30-day mortality in geriatric intensive care unit patients: a multicenter prospective study.

backgroundThis study aimed to assess nutritional risk in older adults admitted to the intensive care unit (ICU) from the emergency department (ED) and to examine its relationship with 30-day mortality by comparing nutritional assessment tools with physiological severity scores.

methodThe study was conducted simultaneously across 20 EDs. Patients aged 65 years and older who presented to the ED and were subsequently admitted to the ICU were included. Nutritional risk scores including the Nutritional Risk Screening-2002 (NRS-2002), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST), and modified Nutrition Risk in the Critically Ill (mNUTRIC) and clinical severity scores, including the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were calculated using parameters obtained at ED presentation. Univariate and multivariate logistic regression analyses were performed to identify predictors of 30-day mortality.

resultsA total of 150 patients were included, with a 30-day mortality rate of 21.3%. In multivariate logistic regression analysis, SOFA score independently predicted 30-day mortality (OR: 1.30 per point increase, 95% CI: 1.03-1.63; p = 0.028). ROC analysis showed excellent discriminative ability for SOFA (AUC = 0.87), APACHE II (AUC = 0.85), and mNUTRIC (AUC = 0.83), while GNRI demonstrated good predictive performance (AUC = 0.79). NRS-2002 (AUC = 0.67) and MUST (AUC = 0.66) showed poor discriminative ability. DeLong comparisons showed no significant differences among SOFA, APACHE II, mNUTRIC, and GNRI (all p > 0.05), while these scores performed significantly better than NRS-2002 and MUST (p < 0.01).

conclusionAmong the nutritional assessment tools evaluated, the mNUTRIC score demonstrated good discriminative ability for predicting 30-day mortality in geriatric ICU patients admitted from the ED. However, among all evaluated parameters, the SOFA score was the only independent predictor of 30-day mortality.