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Original Articles

Nutrition
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: Sung Bak An, Dong Woo Shin; Acute Crit Care. 2026;41(2):399-410. Published online May 28, 2026; DOI: https://doi.org/10.4266/acc.001170

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Abstract PDF: 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.

Meta-analysis
Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea: Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim; Acute Crit Care. 2024;39(1):127-137. Published online February 20, 2024; DOI: https://doi.org/10.4266/acc.2023.01613

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232 Download
17 Web of Science
21 Crossref

Abstract PDF Supplementary Material

Background
The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.
Methods
Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.
Results
The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3–7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5–8; PNI: 35–38) or severe (CONUT: 9–12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0–1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24–1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95–3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09–1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67–2.12; P<0.001).
Conclusions
The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

Citations

Citations to this article as recorded by

Research Progress on the Impact of Prognostic Nutritional Index on the Prognosis of Inflammatory Diseases
雪梅
Advances in Clinical Medicine.2026; 16(02): 93. CrossRef
Geriatric nutritional risk index as a predictor of 28-day and 365-day mortality in patients with heart failure complicated by sepsis: A retrospective cohort study using the MIMIC-IV database
Yameng Wang, Maosheng Wang, Ling Wang, Qi Tang, Yuanping Wang, Xiangyun Teng, Lili Jin
Journal of Acute Disease.2026;[Epub] CrossRef
Prognostic Value of Nutritional Risk Scores in Septic ICU Patients: A Survival Analysis Using mNUTRIC, PNI, and CONUT
Marius Bogdan Novac, Gabriel-Petre Gorecki, Alin Pătru, Anda Lorena Dijmărescu, Diana-Ruxandra Hădăreanu, Mohamed-Zakaria Assani, Lidia Boldeanu, Mihail Virgil Boldeanu, George Alin Stoica
Diagnostics.2026; 16(8): 1193. CrossRef
Prognostic nutritional index, Naples prognostic score and Osaka prognostic score as predictors of acute respiratory distress syndrome in non-diabetes mellitus patients with sepsis: a loss of predictive efficacy of NPS and OPS in diabetes mellitus cohorts
Jie Wu, Wenfeng Qiu, Xiuwen Lin, Jinrun Wu, Renyuan Li
Frontiers in Endocrinology.2026;[Epub] CrossRef
Sepsis in multimorbidity: a domain-based framework for systemic vulnerability and precision care
Jhan S. Saavedra-Torres, Humberto Alejandro Nati-Castillo, Alice Gaibor-Pazmiño, Wilder Fernando Ortiz Erazo, María Alejandra Martínez Castaño, Cristhian Camilo Nieto Brandon, Diana Catalina Parra Ramos, Juan Villamil, Leonardo Sánchez S., Andrés López-Co
Frontiers in Medicine.2026;[Epub] CrossRef
Comparative Prognostic Accuracy of Objective Nutritional Indices in Critically Ill Patients with Sepsis: A Systematic Review and Meta-Analysis
Yan-Wu Yang, Yan Zhang, Tian-Yi Qu, Mei-Ling Ge, Zhi Wan
Journal of Clinical Medicine.2026; 15(10): 3885. CrossRef
Lactate-Modified Prognostic Nutritional Index (LPNI) and Its Association with ICU Mortality in Patients with Sepsis: A Retrospective Cohort Study
Xiaoqing Li, Shuyuan Qian, Hui Chen, Xueyan Yuan, Xinyu Xia, Xiaohui Gao, Guanjie Chen
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Comparison of the mNUTRIC Score and the PNI for Predicting 30-Day Mortality in Geriatric Patients in the ICU
Berkay Küçük, Emine Vural Yalçın
British Journal of Hospital Medicine.2026;[Epub] CrossRef
Development of an early prediction model for ICU-acquired weakness in sepsis using PNI and SII
Bing Sun, Changhua Jiang, Wanjun Jian
The International Journal of Artificial Organs.2026;[Epub] CrossRef
Relationship between the geriatric nutritional risk index and sepsis in elderly critically ill patients: a retrospective cohort study
Yujiao Jin, Tianyun Zhou, Chenshu Hou, Huihui Zhang, Binbin Xu
European Journal of Medical Research.2025;[Epub] CrossRef
Epidemiology and Microbiology of Healthcare-Associated Infections in Neurosurgery Department: A Cross-Sectional Study
Renata Jabłońska, Paweł Sokal, Magdalena Zając, Agnieszka Królikowska, Karolina Filipska - Blejder, Irena Wrońska, Robert Ślusarz
Biological Research For Nursing.2025; 27(4): 544. CrossRef
Prognostic nutritional index as a potential predictor of prognosis in patients with sepsis: a retrospective cohort study
Mingyuan Pan, Zheng Li, Shanfeng Sheng, Xiao Teng, Yuyang Li
Frontiers in Nutrition.2025;[Epub] CrossRef
The J-shaped association between the ratio of neutrophil counts to prognostic nutritional index and mortality in ICU patients with sepsis: a retrospective study based on the MIMIC database
Jiaqi Lou, Hong Kong, Ziyi Xiang, Xiaoyu Zhu, Shengyong Cui, Jiliang Li, Guoying Jin, Neng Huang, Xin Le, Youfen Fan, Sida Xu
Frontiers in Cellular and Infection Microbiology.2025;[Epub] CrossRef
Recurrent Bloodstream Infections Without Sepsis in a Patient With Short Bowel Syndrome on Parenteral Nutrition: A Case of Potential Sepsis Tolerance
Akiva Brin , Sarah Israel , Sigal Matza-Porges , Zvi Ackerman
Cureus.2025;[Epub] CrossRef
Dynamic assessment of clinical scales for predicting mortality in septic patients with prolonged ICU stay
M. Ya. Yadgarov, L. B. Berikashvili, I. V. Kuznetsov, K. K. Kadantseva, A. A. Yakovlev, V. V. Likhvantsev
Messenger of ANESTHESIOLOGY AND RESUSCITATION.2025; 22(4): 6. CrossRef
The impact of the prognostic significance of the CONUT score on critical care patients in the intensive care unit: a descriptive study
Melike Yüksel Yavuz, Hüseyin Döngelli, Mehmet Yavuz, Ceyda Anar, Muzaffer Onur Turan, Bünyamin Sertoğullarından
Nutrición Hospitalaria.2025;[Epub] CrossRef
Can Nutritional Screening Tools Predict the Prognosis of Critically Ill Patients with Sepsis?
Duygu Kayar Calili, Demet Bolukbasi, Seval Izdes
Medicina.2025; 61(10): 1846. CrossRef
Prognostic value of the advanced lung cancer inflammation index for 28 day mortality in sepsis associated acute kidney injury
Mengfei Li, Runbing Xu, Yu Wu, Jiajun Pan, Xinyu Zhang, Miao Jiang
Scientific Reports.2025;[Epub] CrossRef
Prognostic Nutritional Index and Urea-albumin Ratio: Novel Mortality Predictors for Critically Ill Sepsis Patients
Tugce Damarsoy, Hasan T Gozdas, Isa Yildiz, Abdullah Demirhan
Indian Journal of Critical Care Medicine.2025; 29(12): 996. CrossRef
Development and validation of a predictive model for in-hospital mortality from perioperative bacteremia in gastrointestinal surgery
Yusuke Taki, Shinsuke Sato, Masaya Watanabe, Ko Ohata, Hideyuki Kanemoto, Noriyuki Oba
European Journal of Clinical Microbiology & Infectious Diseases.2024; 43(11): 2117. CrossRef
Sepsis and Septic Shock Management and Care: A Case Presentation
Myriam Jean Cadet
MEDSURG Nursing.2024; 33(5): 214. CrossRef

Meta-analysis
Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran: Ghazaleh Eslamian, Sohrab Sali, Mansour Babaei, Karim Parastouei, Dorsa Arman Moghadam; Acute Crit Care. 2022;37(3):332-338. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2021.01830

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209 Download
3 Web of Science
3 Crossref

Abstract PDF

Background
Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.
Methods
In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.
Results
In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).
Conclusions
Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.

Citations

Citations to this article as recorded by

Computational methods for studying relationship between nutritional status and respiratory viral diseases: a systematic review
Zakir Hussain, Malaya Dutta Borah, Rezaul Karim Ahmed
Artificial Intelligence Review.2024;[Epub] CrossRef
A Novel Facet of In-Hospital Food Consumption Associated with Hospital Mortality in Patients with Scheduled Admission—Addition of a Study Protocol to Test the Existence of Effects of COVID-19 in the Same Study in the Post-COVID-19 Period
Hiroyo Miyata, Ayako Tsunou, Yoko Hokotachi, Teruyoshi Amagai
Nutrients.2024; 16(14): 2327. CrossRef
Predictive value of multiple variable models including nutritional risk score (NRS 2002) on mortality and length of stay of patients with covid-19 infections. The INCOVO study
Ghadamieh Fatemeh, Ginette Fotsing, Pedro Marques-Vidal, Peter Kopp, Mohammed Barigou
Clinical Nutrition ESPEN.2023; 55: 357. CrossRef

Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study: Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin; Korean J Crit Care Med. 2012;27(3):157-164.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.157

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4 Crossref

Abstract PDF

BACKGROUND
Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes.
METHODS
This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition.
RESULTS
According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.

Citations

Citations to this article as recorded by

Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
Yunjin Sohn, Taisun Hyun
Korean Journal of Community Nutrition.2022; 27(2): 121. CrossRef
Comparison of the nutritional indicators of critically Ill patients on extracorporeal membrane oxygen (ECMO)
Nah-Mee Shin, Suk Yeon Ha, Yoon Soo Cho
Journal of Nutrition and Health.2021; 54(5): 489. CrossRef
The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit
H J Jo, D B Shin, B K Koo, E S Ko, H J Yeo, W H Cho
European Journal of Clinical Nutrition.2017; 71(11): 1360. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
Journal of Nutrition and Health.2015; 48(3): 211. CrossRef

Effects of APACHE II Score and Initial Nutritional Status on Prognosis of the Critically Ill Patients: Seohui Ahn, Se Hee Na, Chul Ho Chang, Hyunsun Lim, Duk Chul Lee, Cheung Soo Shin; Korean J Crit Care Med. 2012;27(2):102-107.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.102

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110 Download
5 Crossref

Abstract PDF

BACKGROUND
Malnutrition is common in hospitalized patients, especially in critically ill patients and affects their mortality and morbidity. However, the correlation between malnutrition and poor outcome is not fully understood. Our hypothesis is that the nutritional effect on the patient's prognosis would differ depending on the severity of the disease.
METHODS
3,758 patients admitted to the intensive care unit (ICU) were observed retrospectively. Patients were divided into well, moderate and severe groups, according to their nutritional status as assessed by their serum albumin level and total lymphocyte count (TLC). The severity of the disease was assessed by the Acute Physiologic and Chronic Health Evaluation (APACHE II score). All patients were followed clinically until discharge or death and ICU days, hospital days, ventilator days, and mortality rates were recorded.
RESULTS
Depending on the definition used, the prevalence of hospital malnutrition is reported to be 68.3%. Hospital days, ICU days, as well as ventilator days of moderate and severe groups were longer than the well group. In patients exhibiting mild severity of disease, moderate and severe malnutrition groups have 3-5 times the mortality rate than the well group.
CONCLUSIONS
Malnutrition affects the prognosis of patients who have an APACHE II score ranging from 4-29 points. Active nutritional support may be more effective for patients with a disease of mild severity.

Citations

Citations to this article as recorded by

Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
Won Kee Seo, Hyunjung Kim
Journal of Korean Biological Nursing Science.2024; 26(1): 16. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
Journal of Nutrition and Health.2015; 48(3): 211. CrossRef
Comparison of nutritional status indicators according to feeding methods in patients with acute stroke
Sanghee Kim, Youngsoon Byeon
Nutritional Neuroscience.2014; 17(3): 138. CrossRef
Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis
Seung Hwan Lee, Ji Young Jang, Jae Gil Lee
Korean Journal of Critical Care Medicine.2013; 28(4): 247. CrossRef
Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean Journal of Critical Care Medicine.2012; 27(3): 157. CrossRef

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