88 Validation of the Modified NUTrition Risk Score (mNUTRIC) in Burn Victims: Evidence from a Multi-centre, Multi-national, Double-blind, Controlled Randomized Clinical Trial
Authors: Heyland Daren , Ortiz Luis A , Turgeon Alexis F , Wibbenmeyer Lucy , Pollack Jonathan , Mandell Samuel P , Eshraghi Niknam , Day Andrew G 
Published: March 2020

Abstract

Introduction
Nutrition is an essential therapy in burn victims. However, whether nutrition therapy provide benefits equally to all burn victims is unknown. The NUTRIC score identifies patients who may not benefit more from aggressive nutrition therapy (score &lt; 5) and those who may benefit more from aggressive nutrition (High score ≥ 5). It can be estimated from age, SOFA, APACHE scores, comorbidities, and IL-6. If the latter is not available, the modified NUTRIC score (mNUTRIC) can be computed. The mNUTRIC score has been validated in ICU settings. In burn victims, the association between mNUTRIC score, nutritional intake, and clinical outcomes is unknown. We hypothesize that a higher mNUTRIC score will be associated with worst clinical outcomes and that greater nutritional adequacy will be associated with better clinical outcomes in nutritionally high-risk burn victims.

Methods
In the context of a double-blind, placebo-active, multi-centre RCT of adult burn patients, we evaluated the association between mNUTRIC score, nutritional adequacy, and clinical outcomes. Patients with deep second and/or third-degree burns with a total body surface area percentage (TBSA%) ≥10 were enrolled in the RCT. Patients demographics, type of burn, %TBSA, nutrition intake, hospital length of stay (LOS), Burn Unit (BU) LOS, and hospital mortality were collected. The nutritional adequacy was calculated from all sources, except intravenous glucose and oral intake. Descriptive and inferential analyses for quantitative data were performed.

Results
Six hundred and sixty patients were included. The majority were Caucasian (78%) males (74%) with a BMI between 25–35 (53%), median age of 50 ±18 years and severely ill (Apache Score II; 14 ±8, SOFA score; 2.9 ±3). The most common type of burn was fire (87%), with %TBSA of 31 ±16, Table 1. EN alone was provided to 79% of the patients and the daily average energy and protein adequacy was 73% and 76%, accordingly. Table 2. Compared to low mNUTRIC, the high mNUTRIC group had less ventilator free days (11 [6–19] vs. 28 [11–28] days), worse survival (52% vs. 9.5%), and longer hospital LOS (181 [81–181] vs. 34 [20–68] days), Table 3. Compared to the low mNUTRIC, the high mNUTRIC group had better clinical outcomes with increasing energy (by 20% of goal), interaction for energy, mNUTRIC, and mortality was p=0.11 and for time-discharge-alive was &lt; p=0.0001. Similarly, more protein tended towards better outcomes in the high mNUTRIC group but not the low NUTRIC group (interaction for protein, mNUTRIC, mortality was p=0.20; time-to-discharge alive was p=0.08, Table 4.

Conclusions
A high mNUTRIC score identifies high risk burn victims and may identify those who may benefit more from an aggressive nutrition therapy.

Applicability of Research to Practice
Nutrition therapy in burns can be more efficient.