Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients
Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients
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DOI：
10.1093/ndt/gfh143
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发表时间：
2004-06-01
影响因子：
6.1
通讯作者：
Block, G
中科院分区：
文献类型：
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作者：
Kalantar-Zadeh, K;Kopple, JD;Block, G
背景资料。据报道，营养不良-炎症复合体综合征(MICS)的标志物可以预测维持性血液透析(MHD)患者的死亡率和住院时间。然而，目前还不清楚哪一个更敏感、更强地预测结果。我们考察了MICS的10项标志物作为预测未来死亡率和住院的有效性，包括营养不良-炎症评分(MIS)、血清C-反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、白蛋白、前白蛋白、总铁结合力、肌酐、总胆固醇和标准蛋白氮的水平。从洛杉矶南湾地区的8个DaVita透析机构中随机选择了378名MHD患者作为研究对象。患者年龄为54.5+/-14.7岁，其中53%为男性，47%为西班牙裔，30%为非裔美国人，55%为糖尿病患者，他们接受了37-34个月的MHD。在12个月的随访中，39名患者死亡，208人至少住院一次。多因素Cox和Poisson模型包括11个协变量[性别、年龄、种族、民族、糖尿病、透析年限、Charlson共同发病指数(CCI)、保险状况、Kt/V、体重指数和心血管疾病病史]，以寻找炎症标志物的最高四分位数或营养标志物的最低四分位数。死亡和住院的相对风险大小以管理信息系统、C反应蛋白和IL-6最大。在同时包含所有10个MICS标志物和11个额外协变量的扩展多变量模型中，只有CRP、MICs和CCI是唯一一致的死亡率和住院预测因子，其预后预测能力优于血清白蛋白。管理信息系统似乎是一种有用的短期工具，可以对MHD患者进行风险分层，并可能绕过测量炎症标志物如CRP或IL-6的需要。
Background. Markers of malnutrition-inflammation complex syndrome (MICS) are reported to predict mortality and hospitalization in maintenance haemodialysis (MHD) patients. However, it is not clear which one is a more sensitive and stronger predictor of outcome.Methods. We examined the utility of 10 markers of MICS as predictors of prospective mortality and hospitalization, which included malnutrition-inflammation score (MIS), a fully quantitative score adopted from subjective global assessment, and serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), albumin, prealbumin, total iron binding capacity, creatinine, total cholesterol and normalized protein nitrogen appearance. A cohort of 378 MHD patients, who were randomly selected from eight DaVita dialysis facilities in the South Bay Los Angeles area, was studied.Results. Patients, aged 54.5 +/- 14.7 years, included 53% men, 47% Hispanics, 30% African-Americans and 55% diabetics, who had undergone MHD for 37 34 months. Over a 12-month follow-up, 39 patients died and 208 were hospitalized at least once. Multivariate Cox and Poisson models that included 11 covariates [gender, age, race, ethnicity, diabetes, dialysis vintage, Charlson co-morbidity index (CCI), insurance status, Kt/V, body mass index and history of cardiovascular disease] were explored for the highest quartiles of inflammatory markers or the lowest quartiles of nutritional markers. The magnitude of relative risk of death and hospitalization was greatest for MIS, CRP and IL-6. In extended multivariate models that included all 10 MICS markers and 11 additional covariates simultaneously, CRP, MIS and CCI were the only consistent predictors of mortality and hospitalization, and their outcome predictabilities were superior to serum albumin.Conclusions. The MIS appears to be a useful, short-term tool to risk-stratify MHD patients and may circumvent the need for measuring inflammatory markers such as CRP or IL-6.