Does malnutrition inflammation score maintains its predictive risk assessment in the modern hemodialysis era?

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background and Aims</jats:title> <jats:p>Malnutrition Inflammation score (MIS) is a risk score published in 2001 (Kalantar-Zadeh, 2001) and validated in 2008 (Rambod, 2009). It is associated with a high mortality and morbidity risk in hemodialysis (HD) patients (pts).</jats:p> <jats:p>Currently, HD pts population is composed of much older individuals, submitted to a high efficient treatment with access to pharmacological and nutritional therapy, assured by a bundled payment, when comparing with the validation study population.</jats:p> <jats:p>The objective of this study is to evaluate if MIS maintain its predictive risk assessment.</jats:p> </jats:sec> <jats:sec> <jats:title>Method</jats:title> <jats:p>Cross sectional analysis of HD pts from 25 outpatient clinics. MIS was evaluated at the study baseline. Univariable and multivariable Cox additive regression models were used to analyze the data. C-index was estimated to assess the performance of the final model. A level of significance of = 0.05 was considered.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 2444 pts were analyzed (59.0% males; 32.0% diabetic) during a median period of 48 months (P25=31; P75=48), 875 patients registered MIS&lt;5, corresponding to 35.8%. All-cause mortality was observed in 860 pts (35.2%). There were 202 (35.8%) events in the group of patients with MIS&lt;5, while in the group with MIS5, the number of deaths was higher (658 pts, 41.9%).</jats:p> <jats:p>In univariable analysis using Cox additive model, the main results were:</jats:p> <jats:p>In multivariable analysis, adjusting for age, nPNA, IDWG, Kt/V and diabetes, a MIS 5 and 7 showed, respectively, a HR of 1.761 (IC 95%, p&lt;0.001) and 1.822 (IC 95%, p&lt;0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The findings of this analysis confirms that MIS maintains a discriminative power to identify higher risk of mortality. In this model, age and diabetes also correlate with mortality risk increase, while nPNA, IDWG and Kt/V have the opposite effect.</jats:p> </jats:sec>