title: A comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis.
abstract: OBJECTIVE
  Systemic inflammation-based prognostic scores have prognostic power in patients with cancer, independently of tumor stage and site. Although inflammatory status is associated with mortality in hemodialysis (HD) patients, it remains to be determined as to whether these composite scores are useful in predicting clinical outcomes.
  
  
  METHODS
  We calculated the 6 prognostic scores [Glasgow prognostic score (GPS), modified GPS (mGPS), neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI), which have been established as a useful scoring system in cancer patients. We enrolled 339 patients on regular HD (age: 64 ± 13 years; time on HD: 129 ± 114 months; males/females = 253/85) and followed them for 42 months. The area under the receiver-operating characteristics curve was used to determine which scoring system was more predictive of mortality.
  
  
  RESULTS
  Elevated GPS, mGPS, NLR, PLR, PI and PNI were all associated with total mortality, independent of covariates. If GPS was raised, mGPS, NLR, PLR and PI were also predictive of all-cause mortality and/or hospitalization. GPS and PNI were associated with poor nutritional status. Using overall mortality as an endpoint, the area under the curve (AUC) was significant for a GPS of 0.701 (95% CI: 0.637-0.765; p < 0.01) and for a PNI of 0.616 (95% CI: 0.553-0.768; p = 0.01). However, AUC for hypoalbuminemia (<3.5 g/dl) was comparable to that of GPS (0.695, 95% CI: 0.632-0.759; p < 0.01).
  
  
  CONCLUSIONS
  GPS, based on serum albumin and highly sensitive C-reactive protein, has the most prognostic power for mortality prediction among the prognostic scores in HD patients. However, as the determination of serum albumin reflects mortality similarly to GPS, other composite combinations are needed to provide additional clinical utility beyond that of albumin alone in HD patients.
authors.affiliation: Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kato
authors.affiliation: Division of Nephrology, Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tsuji
authors.affiliation: Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan.
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Sakao
authors.affiliation: Division of Nephrology, Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Naro
authors.initials: N
authors.lastname: Ohashi
authors.affiliation: Division of Nephrology, Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: Division of Nephrology, Maruyama Hospital, Hamamatsu, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Fujimoto
authors.affiliation: Division of Nephrology, Maruyama Hospital, Hamamatsu, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Takita
authors.affiliation: Division of Nephrology, Maruyama Hospital, Hamamatsu, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Furuhashi
authors.affiliation: Department of Clinical Nutrition, School of Food and Nutritional Sciences, University of Shizuoka, Shizuoka, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Kumagai
keywords: Albumin; C-reactive protein; Hemodialysis; Prognosis