title: Association of the malnutrition-inflammation score with clinical outcomes in kidney transplant recipients.
abstract: BACKGROUND
  The combination of chronic malnutrition and inflammation, often termed malnutrition-inflammation complex syndrome or protein-energy wasting, is common in patients with chronic kidney disease. It is associated with increased mortality in patients on maintenance dialysis therapy. We assessed the association of malnutrition-inflammation score (MIS) with all-cause mortality and death-censored transplant loss or death with a functioning transplant in a sample of kidney transplant recipients.
  
  
  METHODS
  Prospective prevalent cohort study.
  
  
  METHODS
  Data from 993 prevalent transplant recipients were analyzed. Sociodemographic parameters, laboratory data, medical and transplant history, comorbid conditions, estimated glomerular filtration rate, and MIS were tabulated at baseline and annually thereafter.
  
  
  METHODS
  MIS, a 30-point scale expressed per 1 standard deviation (1 SD) unit or categorized as <3 (reference), 3-5, 6-8, and >8. The MIS is derived from 10 components, each with 4 levels of severity from 0 (normal) to 3 (severely abnormal). Higher score reflects more severe degree of malnutrition and inflammation status.
  
  
  RESULTS
  All-cause mortality and death-censored transplant loss or death with a functioning transplant. Association of MIS with total mortality was assessed using time-dependent Cox regression analysis, and the association of MIS with death-censored transplant loss or death with a functioning transplant was assessed using semiparametric competing-risks regression analysis.
  
  
  RESULTS
  Mean age was 51 ± 13 years, 57% of patients were men, and 21% had diabetes. Percentages of patients in the MIS categories <3, 3-5, 6-8, and >8 were 40%, 32%, 20%, and 8%, respectively. In multivariable time-dependent Cox regression analyses, time-varying MIS score was a significant predictor of all-cause mortality (HR per 1-SD increase, 1.59; 95% CI, 1.37-1.85), death with a functioning transplant (HR per 1-SD increase, 1.48; 95% CI, 1.23-1.78), and death-censored transplant loss (HR per 1-SD increase, 1.34; 95% CI, 1.04-1.71). Compared with MIS <3, HRs for all-cause mortality for MIS of 3-5, 6-8, and >8 were 1.53 (95% CI, 0.74-3.15), 3.66 (95% CI, 1.87-7.14), and 6.82 (95% CI, 3.34-13.91), respectively.
  
  
  CONCLUSIONS
  Single-center study, small number of outcomes.
  
  
  CONCLUSIONS
  The MIS, a simple tool to assess the presence of malnutrition-inflammation complex syndrome, predicts mortality in kidney transplant recipients.
authors.affiliation: Institute of Pathophysiology, Semmelweis University, Budapest, Hungary. molnar@medformol.hu
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.forename: Maria E
authors.initials: ME
authors.lastname: Czira
authors.forename: Anna
authors.initials: A
authors.lastname: Rudas
authors.forename: Akos
authors.initials: A
authors.lastname: Ujszaszi
authors.forename: Anett
authors.initials: A
authors.lastname: Lindner
authors.forename: Katalin
authors.initials: K
authors.lastname: Fornadi
authors.forename: Istvan
authors.initials: I
authors.lastname: Kiss
authors.forename: Adam
authors.initials: A
authors.lastname: Remport
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.forename: Laszlo
authors.initials: L
authors.lastname: Rosivall
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006801:Humans; D007249:Inflammation; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D044342:Malnutrition; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index