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