Malnutrition-Inflammation Score Associated with Atherosclerosis, Inflammation and Short-Term Outcome in Hemodialysis Patients
Chotima Pisetkul MD*, Kullanuch Chanchairujira MD**, Nucharee Chotipanvittayakul BSc (RT)**, Leena Ong-Ajyooth MD*, Thawee Chanchairujira MD*.
Affiliation : *Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand **Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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 morbid-
ity 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
