A Malnutrition-Inflammation Score is correlated with morbidity and mortality in maintenance hemodialysis patients

Abstract

Malnutrition inflammation complex syndrome (MICS) occurs commonly in maintenance hemodialysis (MHD) patients and may correlate with increased morbidity and mortality. An optimal, comprehensive, quantitative system that assesses MICS could be a useful measure of clinical status and may be a predictor of outcome in MHD patients. We therefore attempted to develop and validate such an instrument, comparing it with conventional measures of nutrition and inflammation, as well as prospective hospitalization and mortality. Using components of the conventional Subjective Global Assessment (SGA), a semiquantitative scale with three severity levels, the Dialysis Malnutrition Score (DMS), a fully quantitative scoring system consisting of 7 SGA components, with total score ranging between 7 (normal) and 35 (severely malnourished), was recently developed. To improve the DMS, we added three new elements to the 7 DMS components: body mass index, serum albumin level, and total iron-binding capacity to represent serum transferrin level. This new comprehensive Malnutrition-Inflammation Score (MIS) has 10 components, each with four levels of severity, from 0 (normal) to 3 (very severe). The sum of all 10 MIS components ranges from 0 to 30, denoting increasing degree of severity. These scores were compared with anthropometric measurements, near-infrared-measured body fat percentage, laboratory measures that included serum C-reactive protein (CRP), and 12-month prospective hospitalization and mortality rates. Eighty-three outpatients (44 men, 39 women; age, 59 +/- 15 years) on MHD therapy for at least 3 months (43 +/- 33 months) were evaluated at the beginning of this study and followed up for 1 year. The SGA, DMS, and MIS were assessed simultaneously on all patients by a trained physician. Case-mix-adjusted correlation coefficients for the MIS were significant for hospitalization days (r = 0.45; P < 0.001) and frequency of hospitalization (r = 0.46; P < 0.001). Compared with the SGA and DMS, most pertinent correlation coefficients were stronger with the MIS. The MIS, but not the SGA or DMS, correlated significantly with creatinine level, hematocrit, and CRP level. During the 12-month follow-up, 9 patients died and 6 patients left the cohort. The Cox proportional hazard-calculated relative risk for death for each 10-unit increase in the MIS was 10.43 (95% confidence interval, 2.28 to 47.64; P = 0.002). The MIS was superior to its components or different subversions for predicting mortality. The MIS appears to be a comprehensive scoring system with significant associations with prospective hospitalization and mortality, as well as measures of nutrition, inflammation, and anemia in MHD patients. The MIS may be superior to the conventional SGA and the DMS, as well as to individual laboratory values, as a predictor of dialysis outcome and an indicator of MICS.

Malnutrition inflammation score is associated with coronary artery disease in hepatitis C virus-infected hemodialysis patients

“…In HD patients, MIS is strongly correlated with the measures of nutrition and inflammation as well as prospective hospitalizations and mortality (Kalantar-Zadeh et al, 2001). In our study, we demonstrated that there is an ongoing and chronic process of malnutrition and inflammation in HCV-infected HD patients with CAD.…”

“…The sum of the 10 components changes between 0 and 30. A higher score reflects a more severe degree of malnutrition and inflammation (Kalantar-Zadeh et al, 2001).…”

“…For the combined assessment of malnutrition and inflammation in hemodialysis (HD) patients, a comprehensive scoring system called 'malnutrition inflammation score' (MIS), which is capable of risk stratifying in HD patients in a quantitative way for optimal management, was developed. MIS is strongly correlated with prospective hospitalizations and mortality, as well as measures of nutrition and inflammation (Kalantar-Zadeh et al, 2001).…”

Kidney Disease Outcomes Quality Initiative (K/DOQI) and the Dialysis Outcomes and Practice Patterns Study (DOPPS): Nutrition guidelines, indicators, and practices

“…The major negative impact of chronic inflammation on nutritional status and survival of patients on maintenance hemodialysis has been documented by many studies, 11,16 and it is clear that the presence of acute or chronic inflammation limits the specificity of serum albumin as a nutritional marker. 1 Markers of inflammation were not routinely measured in the units of the DOPPS; however, we were able to design a Malnutrition Inflammation Score (MIS) from the work of Kalantar-Zadeh et al 20 A modified MIS, ranging from 0 to 30, was devised using DOPPS I data from more than 6,000 patients from the United States, Japan, and Europe, with a higher MIS indicating a worse nutrition-inflammation status. 21 Preliminary results indicate that the average MIS ranged from 5.8 in Japan to 10.7 in Germany, with the other 5 countries ranging from 9.0 to 10.1.…”

Doses intermitentes de estatina em pacientes em hemodiálise com LDL-colesterol espontaneamente baixo

“…The sum of scores ranges from zero to 30 indicates a normal nutritional status or mild malnutrition; a score of 9-18 indicates moderate malnutrition, and a score greater than 18, severe malnutrition. This score provides a correlation coefficient greater than isolated laboratory values and other scores such as SGA 23,24 .…”