Nutritional Risk Assessment and Its Prognostic Impact in Critically Ill Patients with Neurological Diseases

Summary

Here, we present a standardized protocol for nutritional risk assessment, nutritional support evaluation, and prognostic prediction in critically ill patients with nervous system diseases.

Abstract

The research aims to apply and evaluate a standardized protocol for nutritional risk assessment and nutritional support management, and to assess its predictive value in individuals with severe neurological disorders who are at risk of malnutrition. A retrospective analysis was performed on 930 suitable patients hospitalized in the Neurology Intensive Care Unit (NICU) at Xuanwu Hospital, Capital Medical University, between January 2012 and December 2019. At discharge, patients were categorized based on modified Rankin Scale (mRS) results (excellent prognosis: mRS 0-2, n = 600; bad prognosis: mRS 3-6, n = 330) and survival status (survivor: n = 869; deceased: n = 61). The protocol included baseline characteristics and biochemical evaluations, admission Nutritional Risk Screening 2002 (NRS 2002) scores, identifying the nutritional support modality, estimation of typical energy intake throughout the first 7 days, and level of disease evaluation using standardized assessment instruments such as the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and National Institutes of Health Stroke Scale (NIHSS).

Univariate studies, multivariate logistic regression estimation, and receiver operating characteristic (ROC) curve assessment were used to assess predictive significance. The standardized protocol enabled the systematic identification of nutritional risk, stratification of clinical severity, and early guidance for planning nutritional interventions. Key risk indicators, including elevated NRS 2002, APACHE II, and NIHSS scores, advanced age, and inadequate early energy intake, were associated with unfavorable outcomes. In contrast, higher GCS and adequate vitamin B12 levels demonstrated protective tendencies. ROC analysis confirmed that NRS 2002 provided the most effective predictive utility for both functional outcome and survival status. The findings demonstrate that structured nutritional risk assessment and standardized support implementation offer practical value for early prognostic judgment and Nutritional decision-making for severely ill individuals suffering from neurological diseases.

Introduction

Neurocritically ill patients are victims of a severe primary or secondary neurological illness that is often accompanied by dysfunction of systemic organs that necessitate continuous hemodynamic observation, mechanical ventilation, and a multifaceted therapeutic care in the Intensive Care Unit (ICU)^1,2. The patients, with impaired consciousness, dysphagia, mechanical ventilation, and poor spontaneous intake, often cannot engage in adequate nutritional intake, which results in a high rate of nutritional deficiency. Together with hypermetabolic and hypercatabolic stress reactions and physiological deterioration ....

Protocol

This protocol was carried out in accordance with the Declaration of Helsinki¹⁵ and approved by Xuanwu Hospital's Ethics Committee at Capital Medical University. All patients, as well as their legal guardians, provided informed permission.

1. Objects and methods

1. Define inclusion and exclusion criteria.
   1. Set inclusion criteria as follows: age ≥ 14 years, an established diagnostic of serious neurological disorders, a GCS score ≤ 12, or an NIHSS score ≥ 11.
   2. Set exclusion criteria: NCU treatment duration < 7 days, patients with advanced malignanc....

Results

Comparison of general data between the two groups of data
Table 1 shows that patients with serious neurological illnesses have an adverse outcome due to variables including age, APACHE II score, GCS score, NIHSS score, dietary intake techniques, vitamin B12 levels, and albumin levels (P < 0.05).

Logistic regression analysis
The poor prognosis was used as the dependent variable (poor prognosis = 1, good prognosis = 2). Factors with P.......

Discussion

Previous research has studied the relationship between dietary habits and prognosis in general ICU populations; very limited studies have specifically focused on critically ill neurological patients. The present study is novel in that it integrates nutritional risk screening, energy intake analysis, and neurological severity scales into a single prognostic model. This multidisciplinary approach bridges the existing gap and provides a clinically applicable protocol for early identification and targeted intervention in pat.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automated Biochemical Analyzer	Guilin Youlit Medical Electronics Co., Ltd.	Gui 's equipment is approved for 20172220142	Used for detecting serum protein, liver/kidney function, and infection markers
Bedside Ultrasound Machine	Shenzhen Mindray Biomedical Electronics Co., Ltd.	Guangdong machinery injection 20152061288	Equipped with a 3.5–5 MHz abdominal probe; used for monitoring gastric residual volume
Centrifuge	Eppendorf	5810R	Maximum speed 15,000 × g; used for separating serum from venous blood
Disposable Gloves	Kimberly-Clark	KC500	Nitrile, powder-free; worn during blood sample handling
Gastric Tube	ConvaTec	14Fr	Silicone material, sterile; used for EN delivery and gastric residual volume aspiration
Nutritional Risk Screening 2002 (NRS 2002) Scale	European Society of Parenteral and Enteral Nutrition (ESPEN)	N/A	Standardized scale for nutritional risk assessment; scores 0–7 points
Statistical Analysis Software	IBM	SPSS 26.0	Used for descriptive statistics, Logistic regression, and ROC curve analysis
Vacuum Blood Collection Tubes	Shanghai Kehua Laboratory Medical Products Co., Ltd.	Shanghai Machinery Registration 20142410117	used for collecting venous blood samples
Water Swallow Test (WST) Checklist	Xuanwu Hospital Neurology Department	N/A	Customized checklist for evaluating swallowing function in neurocritical patients