A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients

Malnutrition inflammation complex syndrome (MICS) occurs commonly in mainte nance hemodialysis (MHD) patients and may correlate with increased morbidit y and mortality. An optimal, comprehensive, quantitative system that assess es 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 a nd inflammation, as well as prospective hospitalization and mortality. Usin g components of the conventional Subjective Global Assessment (SGA), a semi quantitative scale with three severity levels, the Dialysis Malnutrition Sc ore (DMS), a fully quantitative scoring system consisting of 7 SGA componen ts, with total score ranging between 7 (normal) and 35 (severely malnourish ed), was recently developed. To improve the DMS, we added three new element s to the 7 DMS components: body mass index, serum albumin level, and total iron-binding capacity to represent serum transferrin level. This new compre hensive 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 sever ity. These scores were compared with anthropometric measurements, near-infr ared-measured body fat percentage, laboratory measures that included serum C-reactive protein (CRP), and 12-month prospective hospitalization and mort ality rates. Eighty-three outpatients (44 men, 39 women; age, 59 +/- 15 yea rs) 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, an d 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 hospitalizatio n (r = 0.46; P < 0.001). Compared with the SGA and DMS, most pertinent corr elation coefficients were stronger with the MIS. The MIS, but not the SGA o r DMS, correlated significantly with creatinine level, hematocrit, and CRP level. During the 12-month follow-up, 9 patients died and 6 patients left t he cohort. The Cox proportional hazard-calculated relative risk for death f or each 10-unit increase in the MIS was 10.43 (95% confidence interval, 2.2 8 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 comprehensiv e scoring system with significant associations with prospective hospitaliza tion and mortality, as well as measures of nutrition, inflammation, and ane mia in MHD patients. The MIS may be superior to the conventional SGA and th e DMS, as well as to individual laboratory values, as a predictor of dialys is outcome and an indicator of MICS. (C) 2001 by the National Kidney Founda tion, Inc.