NUTRIC Score Calculator for ICU Nutrition Risk Assessment
The NUTRIC score (Nutrition Risk in Critically Ill) is a validated ICU tool that identifies patients who will benefit most from aggressive nutrition therapy. It incorporates age, APACHE II, SOFA, comorbidities, ICU days, and IL-6.
About
The NUTRIC (Nutrition Risk in Critically Ill) score was developed by Heyland et al. and published in Critical Care Medicine in 2011. It was designed to identify critically ill patients who would benefit from aggressive protein-calorie nutrition therapy by quantifying nutrition risk. The score includes five clinical variables plus optional IL-6: age categories (<50, 50-74, ≥75 years), APACHE II score reflecting acute illness severity, SOFA score quantifying organ dysfunction, number of comorbidities (≥2 = 1 point), days from hospital admission to ICU admission (≥1 day = 1 point), and elevated IL-6 as an inflammatory marker (optional). Total score ranges 0-10 (0-9 without IL-6). A score ≥5 indicates high nutrition risk — these patients derive the greatest mortality benefit from aggressive nutrition therapy.
Formula
Age (0-2) + APACHE II (0-3) + SOFA (0-2) + Comorbidities (0-1) + ICU Days (0-1) + IL-6 (0-1)
The NUTRIC score combines 5-6 clinical variables: Age <50=0, 50-74=1, ≥75=2 points. APACHE II <15=0, 15-19=1, 20-27=2, ≥28=3 points. SOFA <6=0, 6-9=1, ≥10=2 points. Comorbidities ≤1=0, ≥2=1 point. Days in ICU before admission 0=0, ≥1=1 point. IL-6 present or not available=1, absent=0. Total 0-10 (0-9 without IL-6). Score ≥5 indicates high nutrition risk.
Score Interpretation
The NUTRIC score is the first validated ICU nutrition risk assessment tool that specifically identifies patients who benefit from aggressive protein-calorie nutrition therapy. In the original validation study, high-risk patients (NUTRIC ≥5) who received adequate nutrition (≥80% of prescribed calories) had significantly lower 28-day mortality compared to those who received inadequate nutrition. Low-risk patients did not show a mortality benefit from aggressive nutrition. The score has been validated in multiple ICU populations and is endorsed by the Canadian Clinical Practice Guidelines for nutrition support in critically ill patients.
Low Nutrition Risk — 0–4
NUTRIC score 0-4. Low nutrition risk. Standard nutrition support is appropriate.
Management: Standard nutrition support with weekly reassessment.
High Nutrition Risk — 5–10
NUTRIC score ≥5. High nutrition risk. Aggressive nutrition therapy is indicated.
Management: Early enteral nutrition targeting ≥80% of caloric requirements within 48-72 hours. Involve nutrition support team. Monitor for refeeding syndrome.
Reference Ranges
| Population | Normal Range | Notes |
|---|---|---|
| Critically ill ICU patients | 0-10 points | Score ≥5 indicates high nutrition risk. Without IL-6, max score is 9 with threshold ≥5. |
Dr. Ahmed Ismail
Dr. Ahmed Ismail is a board-certified critical care specialist with over 18 years of experience in ICU management.
View medical review board & editorial policy →Example Calculation
A 68-year-old male with septic shock on mechanical ventilation. APACHE II 26, SOFA 11, comorbidities: hypertension and diabetes (2), admitted from ward after 3 days. IL-6 not available. NUTRIC: age 68 (1pt) + APACHE 26 (2pt) + SOFA 11 (2pt) + comorbidities 2 (1pt) + ICU days ≥1 (1pt) + IL-6 not available (1pt) = 8/9 — high nutrition risk. Early enteral nutrition is indicated targeting ≥80% of caloric requirements.
Related Conditions
Related Medications
Common Mistakes
Counting IL-6 as absent when it is simply not measured
If IL-6 is not available, score 1 point (same as present). Only score 0 if IL-6 is confirmed ≤400 pg/mL.
Using NUTRIC for all ICU patients regardless of nutrition status
NUTRIC is specifically for nutrition risk assessment, not for general severity or mortality prediction. Use APACHE II or SOFA for prognostication.
Frequently Asked Questions
What is the threshold for high nutrition risk on NUTRIC?
Can NUTRIC be used in all ICU patients?
References
- Heyland DK, Dhaliwal R, Jiang X, et al. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care Med. 2011;39(6):1308-1317. PubMed
- Rahman A, Hasan RM, Agarwala R, et al. Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the "modified NUTRIC" nutritional risk assessment tool. Clin Nutr. 2016;35(1):158-162. PubMed