Comparative prognostic performance of nutritional assessment tools in critically ill surgical patients after emergency surgery for sepsis or septic shock: a single-center retrospective study in South Korea.

BACKGROUND

Malnutrition is prevalent in critically ill patients. Although various nutritional assessment tools are used in intensive care units (ICUs), their comparative prognostic performance in critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock remains uncertain. We compared the performance of four tools in predicting ICU mortality.

METHODS

We retrospectively analyzed 218 adult critically ill surgical patients requiring postoperative ICU care after emergency surgery for sepsis or septic shock (January 2015-July 2025). Nutritional status was assessed within 24 hours of ICU admission using the Global Leadership Initiative on Malnutrition (GLIM), modified Nutrition Risk in the Critically Ill (mNUTRIC), Nutritional Risk Screening 2002 (NRS-2002), and Malnutrition Universal Screening Tool (MUST). The primary outcome was ICU mortality. Discriminative performance was evaluated using the area under the receiver operating characteristic curve and incremental value over a baseline model (age, sex, Acute Physiology and Chronic Health Evaluation [APACHE] II score, and Sequential Organ Failure Assessment [SOFA] score).

RESULTS

The mNUTRIC score showed the highest crude discrimination for ICU mortality, followed by MUST and GLIM, whereas NRS-2002 demonstrated limited discriminatory ability. When added to the baseline clinical model, MUST and GLIM improved mortality prediction, unlike mNUTRIC. Higher risk categories in MUST and GLIM were associated with increased ICU mortality.

CONCLUSIONS

Prognostic performance varies among nutritional assessment tools. MUST and GLIM provide prognostic information beyond conventional severity scores, whereas the prognostic value of mNUTRIC is largely driven by disease severity, supporting their use for risk stratification in critically ill surgical patients.