J Med Assoc Thai 2010; 93 (1):147

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Malnutrition-Inflammation Score Associated with Atherosclerosis, Inflammation and Short-Term Outcome in Hemodialysis Patients
Pisetkul C Mail, Chanchairujira K , Chotipanvittayakul N , Ong-Ajyooth L , Chanchairujira T

Background: Malnutrition-Inflammation Score (MIS) has been proposed as a new quantitative system for
assessment of malnutrition and inflammation, which are common important risk factors for increased morbidity
and mortality in maintenance hemodialysis (MHD) patients.

Objective:
To determine the MIS and related it to the presence of atherosclerosis, and the morbidity and
mortality rate.

Material and Method: The inflammatory and nutritional status in 100 MHD patients was evaluated by serum
high-sensitivity C-reactive protein (hs-CRP), Subjective Global Assessment (SGA), and MIS. Atherosclerosis
was defined by a history of cardiovascular disease or presence of carotid plaque by B-mode ultrasonography.
Twelve-month prospective hospitalization and mortality rates were recorded.

Results:
The MIS score was significantly higher in patients with atherosclerosis (5.5 + 2.3 vs. 3.0 + 1.7,
p = 0.003) and modestly correlated with serum ferritin level (r = 0.304, p = 0.03), but did not correlated with
hs-CRP. The SGA was not associated with hs-CRP level and atherosclerosis. Over a 12-month follow-up
period, 4 patients died and 28 were hospitalized at least once. Compared to the survivor group, MIS in the
deceased group was significantly higher (8.0 + 1.4 vs. 5.1 + 2.3, p = 0.01) while SGA, hs-CRP and other
biochemical markers were not significantly different. The Receiver Operating Characteristics Curves for the
prediction of 1-year mortality from the MIS score identified the optimal cut-off value of 7.5 with sensitivity of
75% and specificity of 88%. There was no association between MIS or SGA and hospitalization.

Conclusion: MIS is a useful tool for the assessment of malnutrition and inflammatory status. It is superior to the
conventional SGA as a predictor of short-term outcome in MHD patients.

Keywords: Malnutrition-Inflammation Score, Subjective Global Assessment, Atherosclerosis, Morbidity and
Mortality rate, Nutritional status

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