NUTRIC score: how the six-item ICU points total works

The NUTRIC score adds points for six items in an adult ICU patient: age, APACHE II, SOFA, number of comorbidities, days in hospital before ICU admission and interleukin-6 (IL-6). The total runs from 0 to 10, and a total of 6 or more is labeled high risk.

Not a medical device. Not a diagnosis or dosing recommendation.

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Emergency calculators
Heyland DK et al. · 2011
The NUTRIC formula
Worked examples
Frequently asked questions

What is the NUTRIC score?

NUTRIC stands for Nutrition Risk in the Critically ill. Heyland and colleagues described it in Critical Care in 2011. Each of the six items is split into bands, and each band carries a fixed number of points.

Magent's calculator uses the paper's Table 4 version that includes IL-6. It returns the total, the maximum of 10 and a high_risk flag that is true when the total is 6 or more.

This page explains how the points add up. It doesn't say what a score means for a particular person.

The NUTRIC formula

NUTRIC = age points + APACHE II points + SOFA points
       + comorbidity points + hospital-days points + IL-6 points

age            < 50 → 0     50 to < 75 → 1     ≥ 75 → 2
APACHE II      < 15 → 0     15 to < 20 → 1     20 to 28 → 2     ≥ 29 → 3
SOFA           < 6  → 0     6 to < 10  → 1     ≥ 10 → 2
comorbidities  0 or 1 → 0   ≥ 2 → 1
hospital days before ICU    < 1 → 0            ≥ 1 → 1
IL-6 (pg/mL)   < 400 → 0    ≥ 400 → 1

maximum 10 · high_risk when total ≥ 6

Exact expression the calculator uses:

NUTRIC = age (0–2) + apache_ii (0–3) + sofa (0–2) + comorbidities (0–1) + hospital_days_to_icu (0–1) + il6_pg_ml (0–1); Heyland 2011 Table 4 overall including IL-6; max 10; high_risk if score ≥ 6

Inputs

Input	Meaning	Accepted range
`age`	Age in years	18 to 120
`apache_ii`	APACHE II score	0 to 71
`sofa`	SOFA score	0 to 24
`comorbidities`	Number of comorbidities	0 to 20
`hospital_days_to_icu`	Days in hospital before ICU admission	0 to 365
`il6_pg_ml`	Interleukin-6, pg/mL	0 to 100000

How the calculation works

Age: under 50 scores 0, 50 up to 75 scores 1, 75 or more scores 2.
APACHE II: under 15 scores 0, 15 up to 20 scores 1, 20 to 28 scores 2 (28 is in this band), 29 or more scores 3.
SOFA: under 6 scores 0, 6 up to 10 scores 1, 10 or more scores 2.
Comorbidities: 0 or 1 scores 0; 2 or more scores 1.
Hospital days before ICU: under 1 day scores 0; 1 day or more scores 1.
IL-6: under 400 pg/mL scores 0; 400 or more scores 1.
Add the six item points. The total is 0 to 10. high_risk is true when the total is 6 or more.

Units

APACHE II and SOFA are entered as already-calculated scores; the calculator doesn't work them out. IL-6 is in pg/mL. Hospital days count the time from hospital admission to ICU admission. A missing value or one outside its range is rejected with an error.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: no scoring items

Age 40, APACHE II 10, SOFA 4, no comorbidities, 0 hospital days, IL-6 100 pg/mL.

Every item falls in its lowest band → 0 points each.
Total 0; high_risk false.

Example 2: APACHE II at 29

All other items in their lowest bands.

APACHE II 29 is in the top band → 3 points.
Total 3; high_risk false.

Example 3: reaching the high-risk cut-off

Age 75, APACHE II 20, SOFA 10, other items in their lowest bands.

Age 75 → 2. APACHE II 20 → 2. SOFA 10 → 2.
Total 6; high_risk true.

Example 4: every item at its top band

Age 120, APACHE II 71, SOFA 24, 20 comorbidities, 365 hospital days, IL-6 100000 pg/mL.

2 + 3 + 2 + 1 + 1 + 1.
Total 10, the maximum; high_risk true.

History of the NUTRIC score

The calculator cites Heyland and colleagues, Critical Care, 2011 (volume 15, issue 6, article R268). The abstract describes a prospective observational study of ICU patients. Candidate items included age, APACHE II, SOFA, comorbidities, days from hospital to ICU admission, body mass index, recent oral intake, weight loss, IL-6, procalcitonin and C-reactive protein. Bands of each item were given points by their link with 28-day mortality. Body mass index, C-reactive protein, procalcitonin, oral intake and weight loss were not kept in the final score.

When it's used

The score is applied to adults in intensive care, using values from around the time of ICU admission.

Where it's used

The NUTRIC score needs an APACHE II score, a SOFA score, a comorbidity count, the admission dates and an IL-6 result. These come from an ICU setting.

Who uses it

The person using the calculator enters the six values. The calculator assigns the band points, adds them and sets the high_risk flag.

Limits of the calculation

The calculator doesn't compute APACHE II or SOFA, count comorbidities or measure IL-6. All six values come from the person entering them.
It's the version with IL-6. It isn't the modified NUTRIC score that leaves IL-6 out.
The high_risk flag uses the cut-off of 6. No other cut-offs are applied.
It isn't a feeding order, and this page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

Nutritional Risk Screening (NRS) grades nutritional status and disease severity and adds an age point. It has no lab value and no ICU severity score.

Glossary

APACHE II: an ICU illness severity score, entered as a number.
SOFA: Sequential Organ Failure Assessment, a score of organ dysfunction, entered as a number.
IL-6: interleukin-6, a blood marker of inflammation, in pg/mL.
Comorbidities: other long-term conditions the patient has.

Common mistakes

Putting APACHE II 28 in the top band. 28 is in the 20 to 28 band and scores 2. The top band starts at 29.
Using the version without IL-6. This calculator adds an IL-6 item, so its maximum is 10.
Counting a part day as a full hospital day. The hospital-days point starts at 1 day.
Reading the flag as a care plan. high_risk reports the total against the cut-off of 6, nothing more.

Source

Heyland DK, 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. 2011;15(6):R268. DOI: 10.1186/cc10546. PMID: 22085763

Frequently asked questions

How is the NUTRIC score calculated?

Each of six items gets 0 to 3 points by band, and the points are added. The total runs from 0 to 10.

What NUTRIC score is high risk?

A total of 6 or more sets high_risk to true.

Is this the same as the modified NUTRIC score?

No. This version includes IL-6. The modified version leaves IL-6 out.

Which band does APACHE II 28 fall in?

The 20 to 28 band, which scores 2.

Does the calculator work out APACHE II or SOFA?

No. Both are entered as already-calculated scores.