APACHE II and NUTRIC Scores for Mortality Prediction in Chronic Critical Illness: A "Right-Side" Prognostic Modeling Approach.

Background/Objectives: Accurate prognostication for patients with chronic critical illness (CCI) following brain injury remains challenging. Conventional scoring systems like the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Nutrition Risk in the Critically Ill (NUTRIC) score are validated as "left-side" models for risk stratification at intensive care unit (ICU) admission but may not capture the evolving trajectory of prolonged illness. This study aimed to evaluate the prognostic performance of APACHE II and NUTRIC as "right-side" models-assessed at intervals closer to the outcome-by testing the hypothesis that their predictive accuracy for in-hospital mortality improves when measured nearer to the time of death. Methods: In this real-world data analysis study, data were extracted from the electronic health records (Russian Intensive Care Dataset [RICD] v. 2.0) of 328 adult patients with CCI following brain injury. The discriminative ability of repeatedly assessed APACHE II and NUTRIC scores for predicting mortality was analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for three predefined intervals before death: within ≤7 days, 8-14 days, and ≥15 days. Results: Among the 328 patients (median age 64 years; 18.3% in-hospital mortality), a total of 380 paired score assessments were analyzed. The predictive performance for both scores was highest within 7 days of death (APACHE II AUROC: 0.883; NUTRIC AUROC: 0.839). Discriminatory ability declined at 8-14 days (APACHE II AUROC: 0.807; NUTRIC AUROC: 0.778) and was poorest at ≥15 days before death (APACHE II AUROC: 0.671; NUTRIC AUROC: 0.681). The NUTRIC score consistently demonstrated higher AUROC values than APACHE II across all intervals, though the differences were not statistically significant. Conclusions: In patients with CCI following brain injury, the prognostic accuracy of APACHE II and NUTRIC scores is time-dependent, peaking immediately before death and offering poor long-term prediction from admission. These findings underscore the limitation of static, admission-based models and highlight the necessity for developing dynamic, personalized and time-sensitive prognostic tools tailored to the evolving course of chronic critical illness.