Assessment of Malnutrition Among Critically Ill Adults Admitted in the ICU of a Tertiary Care Hospital at Rawalpindi, Pakistan

Abstract

Objective: To determine the prevalence and clinical implications of nutritional risk among critically ill adults admitted to the ICU at Fauji Foundation Hospital, Rawalpindi, Pakistan.

Methodology: This prospective observational study enrolled 250 adult ICU patients admitted for 7–60 days between January 2023 and July 2023. Nutritional risk was assessed at admission and discharge using validated NRS-2002 and mNUTRIC scores, and MUAC was measured as an anthropometric indicator. Multivariate logistic regression analysis was performed to evaluate the association between nutritional risk markers and clinical outcomes, including mortality and length of stay (LOS).

Results: Most patients (62.8%) were older than 40 years, with a majority being female (74%). A high prevalence of nutritional risk was observed at admission (62.4% by NRS-2002 and 27.2% by mNUTRIC), which increased to 69.6% and 88%, respectively, at discharge or death. MUAC showed a significant decline from admission to discharge (?2.10 cm in males and ?1.70 cm in females). The ICU mortality rate was 43%. Higher NRS-2002 scores (OR: 1.42; 95% CI: 1.13–1.77; p = 0.002) and mNUTRIC scores (OR: 2.85; 95% CI: 2.09–3.90; p < 0.001) at admission were independently associated with increased mortality. A decline in MUAC was also linked to higher mortality (OR: 1.26; 95% CI: 1.10–1.70; p = 0.007) and prolonged LOS (OR: 1.19; 95% CI: 1.01–1.40; p = 0.034).

Conclusion: This study reveals a high prevalence of malnutrition (62.4%–69.6%) among ICU patients, which is strongly associated with adverse clinical outcomes. These findings underscore the need for routine nutritional screening using validated tools such as NRS-2002 and mNUTRIC, particularly in resource-limited settings, to enable early detection and timely interventions that can improve patient outcomes.