Clinical utility of malnutrition-inflammation score in maintenance hemodialysis patients: focus on identifying the best cut-off point.
BACKGROUND
Malnutrition-inflammation score (MIS) is a comprehensive and quantitative system to assess malnutrition-inflammation complex syndrome, and a strong correlation between MIS and morbidity/mortality in maintenance hemodialysis (MHD) patients had been demonstrated. However, there is no cut-off value of MIS to categorize patients into high risk or low risk patients.


METHODS
A total of 257 chronic stable and ambulatory adult MHD patients from Far Eastern Memorial Hospital were enrolled for the study. The MIS of each patient was recorded at the initiation of study and the study population was followed up as a 12-month prospective cohort to evaluate mortality as the primary outcome.


RESULTS
Twelve patients died in the 12-month observational period. Both multiple logistic regression analyses and Cox proportional hazards model denoted MIS, alkaline phosphatase, transferrin saturation, ferritin, and total iron binding capacity as significant predictors of 1-year mortality. The conditional effect plot of MIS on 1-year mortality revealed that when fixing the alkaline phosphatase, transferrin saturation, ferritin, and total iron binding capacity at a mean value, the probability of death for an MHD patient whose MIS was 3, 4, and 5 is 10, 40, and 80%, respectively.


CONCLUSIONS
Our study shows that MHD patients with MIS score of more than 4-5 had a significant risk of 1-year mortality. Additional risk factors associated with short-term mortality besides malnutrition-inflammation complex syndrome were anemia and renal osteodystrophy. This study proves that MIS is a useful tool to risk-stratify Asian MHD patients and to identify those at risk of short-term death. Nutritional interventions that can improve the MIS may also improve survival, but this hypothesis needs to be verified in interventional studies.
Department of Internal Medicine, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Li-chun
LC
Ho
His-Hao
HH
Wang
Yu-Sen
YS
Peng
Chih-Kang
CK
Chiang
Jeng-Wen
JW
Huang
Kuan-Yu
KY
Hung
Fu-Chang
FC
Hu
Kwan-Dun
KD
Wu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000175:diagnosis*; D033862:Iron-Binding Proteins / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality*; D013577:Syndrome; D014168:Transferrin / Q000032:analysis
D033862:Iron-Binding Proteins; D014168:Transferrin; D005293:Ferritins; D000469:Alkaline Phosphatase