Prognostic Value of mNUTRIC and CONUT Scores in ICU Patients with Intracranial Hemorrhage

Background: Stroke is the most common neurological disorder in adults and a leading cause of mortality and disability. Intracerebral hemorrhage (ICH), although less frequent than ischemic stroke, is associated with higher morbidity and mortality and often requires ICU admission. Predicting mortality remains challenging due to disease heterogeneity. Objectives: This study evaluated the prognostic value of the modified Nutrition Risk in Critically Ill (mNUTRIC) and Controlling Nutritional Status (CONUT) scores, along with conventional severity scores (GCS, APACHE II, SOFA), in ICU patients with ICH. Methods: This retrospective cohort study included 347 ICU patients with ICH admitted between January 2019 and June 2025. Patients were stratified by survival status and nutritional and conventional severity scores were analyzed. Subgroup analysis was performed in patients with GCS ≤ 12 and APACHE II ≥ 17 (n = 96). Multivariate logistic regression and receiver operating characteristic (ROC) analyses assessed predictive performance. Results: ICU mortality was 24.2%. Deceased patients had lower GCS and higher APACHE II, SOFA, mNUTRIC, and CONUT scores (p < 0.001). Subgroup analysis showed higher mortality in patients with elevated mNUTRIC and CONUT scores (p = 0.038 and p = 0.005). Multivariate analysis identified GCS (OR = 0.675, p < 0.001) and CONUT (OR = 1.174, p = 0.040) as independent predictors; mNUTRIC was not significant. ROC analysis demonstrated good discrimination (AUC 0.818 for mNUTRIC and 0.81 for CONUT), with mNUTRIC being more specific and CONUT more sensitive. Optimal cut-off values were >3 for mNUTRIC and >4 for CONUT. Conclusions: Both mNUTRIC and CONUT scores are associated with mortality in ICU patients with ICH, with CONUT showing independent prognostic value. Their combined use may aid clinical decision-making.