A Malnutrition-Inflammation Score Is Correlated With Morbidity and Mortality in Maintenance Hemodialysis Patients

I read the paper below, which is referenced from the paper I have read previously. This article describes that Malnutrition-Inflammation Score (MIS) is a predictor of dialysis outcome and an indicator of malnutrition inflammation complex syndrome (MICS). MIS was developed from Dialysis Malnutrition Score (DMS), which was developed from Subjective Global Assessment (SGA).

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

Kamyar Kalantar-Zadeh, MD, Joel D. Kopple, MD, Gladys Block, PhD, Michael H. Humphreys, MD

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.

Simplified nutritional screening tools for patients on maintenance hemodialysis

I read the paper below, which describes that MIS is best criteria for assessment of nutrition status of hemodialysis patients. But the method is time-consuming and needs skill. The GNRI is most simple method using only serum albumin, height and body weight for assessment them.

Simplified nutritional screening tools for patients on maintenance hemodialysis

Kohsuke Yamada, Ryuichi Furuya, Takako Takita, Yukitaka Maruyama, Yuri Yamaguchi, Sakae Ohkawa and Hiromichi Kumagai

1 From the Department of Clinical Nutrition, School of Food and Nutritional Sciences and the COE Program in the 21st Century, University of Shizuoka, Shizuoka, Japan (KY, YY, SO, and HK); the Renal Division, Department of Internal Medicine, Iwata City Hospital, Iwata, Shizuoka, Japan (RF); and the Maruyama Hospital, Hamamatsu, Japan (TT and YM)

Background:

Malnutrition is a prevalent complication in patients on maintenance hemodialysis. Nutritional screening tools may be useful to identify those patients at nutritional risk from among hundreds of hemodialysis patients in a large facility.

Objective:

We tested several simplified nutritional screening tools on hemodialysis patients to validate the potential application of the tools.

Design:

The simplified nutritional screening tools were chosen from references published between 1985 and 2005. Nutritional assessments, including history taking, and anthropometric and biochemical measurements were performed on 422 hemodialysis patients. These results were applied to obtain the score of each nutritional screening tool and the malnutrition-inflammation score (MIS), a comprehensive nutritional assessment tool, as the reference standard. The usefulness of each nutritional screening tool for identifying nutritional risk was assessed by comparison with the MIS value and various individual nutritional measures.

Results:

Five reliable nutritional screening tools were found by the literature search. Among them, the geriatric nutritional risk index (GNRI) was considered to be the most accurate in identifying hemodialysis patients at nutritional risk, because the area under the receiver operating characteristic curve generated with the MIS value was the largest. The GNRI showed a significantly negative correlation with the MIS (r = –0.67, P < 0.0001), and the most accurate GNRI cutoff to identify a malnourished patient according to the MIS was <91.2. The GNRI's sensitivity, specificity, and accuracy of <91.2 in predicting malnutrition according to the MIS were 0.730, 0.819, and 0.787, respectively.

Conclusion:

The GNRI was the simplest and most accurate risk index for identifying hemodialysis patients at nutritional risk according to the MIS.

Key Words:

Geriatric nutritional risk index • hemodialysis • nutritional assessment • nutritional screening • malnutrition-inflammation score • nutritional risk