Malnutrition-inflammation score associated with atherosclerosis, inflammation and short-term outcome in hemodialysis patients.
BACKGROUND
Malnutrition-Inflammation Score (MIS) has been proposed as a new quantitative system for assessment of malnutrition and inflammation, which are common important risk factors for increased morbidity and mortality in maintenance hemodialysis (MHD) patients.


OBJECTIVE
To determine the MIS and related it to the presence of atherosclerosis, and the morbidity and mortality rate.


METHODS
The inflammatory and nutritional status in 100 MHD patients was evaluated by serum high-sensitivity C-reactive protein (hs-CRP), Subjective Global Assessment (SGA), and MIS. Atherosclerosis was defined by a history of cardiovascular disease or presence of carotid plaque by B-mode ultrasonography. Twelve-month prospective hospitalization and mortality rates were recorded.


RESULTS
The MIS score was significantly higher in patients with atherosclerosis (5.5 +/- 2.3 vs. 3.0 +/- 1.7, p = 0.003) and modestly correlated with serum ferritin level (r = 0.304, p = 0.03), but did not correlated with hs-CRP. The SGA was not associated with hs-CRP level and atherosclerosis. Over a 12-month follow-up period, 4 patients died and 28 were hospitalized at least once. Compared to the survivor group, MIS in the deceased group was significantly higher (8.0 +/- 1.4 vs. 5.1 +/- 2.3, p = 0.01) while SGA, hs-CRP and other biochemical markers were not significantly different. The Receiver Operating Characteristics Curves for the prediction of 1-year mortality from the MIS score identified the optimal cut-off value of 7.5 with sensitivity of 75% and specificity of 88%. There was no association between MIS or SGA and hospitalization.


CONCLUSIONS
MIS is a useful tool for the assessment of malnutrition and inflammatory status. It is superior to the conventional SGA as a predictor of short-term outcome in MHD patients.
Pisetkul
Chotima
C
Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Chanchairujira
Kullanuch
K
Chotipanvittayakul
Nucharee
N
Ong-Ajyooth
Leena
L
Chanchairujira
Thawee
T
D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D009017:Morbidity; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D013785:Thailand / Q000453:epidemiology; D014463:Ultrasonography
D002097:C-Reactive Protein