Association and Discriminatory Performance of Nutritional Risk and Illness Severity Scores for Low Vitamin D Status in Critically Ill Adults

Abstract

Low vitamin D status is common in critically ill patients, but whether routinely available nutritional-risk and illness-severity scores can identify patients with low serum 25-hydroxyvitamin D [25(OH)D] remains uncertain. This analytical cross-sectional study included 73 adult patients admitted to the intensive care unit of Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. Nutritional risk was assessed using Nutritional Risk Screening 2002 (NRS-2002) and modified Nutrition Risk in the Critically Ill (mNUTRIC), while illness severity was assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA). Serum 25(OH)D was measured using a chemiluminescent microparticle immunoassay. Associations between clinical scores and serum 25(OH)D were evaluated using Spearman correlation, and discriminatory performance for low vitamin D status (<30 ng/mL) was assessed using receiver operating characteristic analysis. Low vitamin D status was present in 66 of 73 participants (90.4%). Serum 25(OH)D was not significantly correlated with NRS-2002 (ρ=0.171, p=0.148), modified NUTRIC (ρ=0.223, p=0.058), or SOFA (ρ=−0.048, p=0.689). APACHE II showed a weak positive correlation with 25(OH)D (ρ=0.242, p=0.039). None of the four scores demonstrated significant discrimination for low vitamin D status: AUCs were 0.576 for NRS-2002, 0.422 for modified NUTRIC, 0.345 for APACHE II, and 0.450 for SOFA. Routine nutritional-risk and illness-severity scores showed limited ability to identify low vitamin D status and should not be considered substitutes for direct serum 25(OH)D measurement.