title: Malnutrition Inflammation Score cut-off predicting mortality in maintenance hemodialysis patients.
abstract: BACKGROUND
  Malnutrition is a strong predictor of mortality on hemodialysis patients, especially when it is associated with inflammation. Malnutrition Inflammation Score (MIS) is a simple and low cost tool which assesses the presence of malnutrition associated with inflammation. Therefore, the aim is to evaluate if MIS is associated with mortality in patients on maintenance hemodialysis and establish a cut-off to predict mortality at different follow-up periods.
  
  
  METHODS
  Observational retrospective cohort study including 215 patients on hemodialysis between July 2012 and June 2014, censored until November 2015. MIS was used to assess patient's nutritional status at the moment they were enrolled in the study. They were followed for at least 18 months.
  
  
  RESULTS
  At the end of 18 months, 38 (17.7%) deaths, 20 renal transplants (9.3%), four facilities transference (1.9%), three dialysis method change (1.4%) and one renal function recovery (0.5%) were observed. One hundred seventy one patients completed at least 24 months of follow-up, and during this additional period, there were five deaths and one renal transplant more. Score higher than 7 points was able to predict mortality for both follow-up periods using sensitivity and specificity analysis and ROC curves. Using this cut-off on Kaplan-Meier survival curve, it was possible to confirm the association of MIS with all-cause mortality at 18 months and 24 or more months of follow-up. Finally, Cox multivariate analysis adjusted for demographic, clinical and nutritional variables showed MIS as the only significant predictor of mortality.
  
  
  CONCLUSIONS
  MIS is an independent predictor of mortality in hemodialysis patients.
authors.affiliation: Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil.
authors.forename: Mariana Clementoni Costa
authors.initials: MC
authors.lastname: Borges
authors.affiliation: Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil.
authors.forename: Barbara Perez
authors.initials: BP
authors.lastname: Vogt
authors.affiliation: Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil.
authors.forename: Luis Cuadrado
authors.initials: LC
authors.lastname: Martin
authors.affiliation: Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil. Electronic address: jteixeir@fmb.unesp.br.
authors.forename: Jacqueline Costa Teixeira
authors.initials: JC
authors.lastname: Caramori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hemodialysis; Malnutrition Inflammation Score; Mortality; Nutritional assessment