A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients
A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients
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DOI：
10.1053/ajkd.2001.29222
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发表时间：
2001-12-01
影响因子：
13.2
通讯作者：
Humphreys, MH
中科院分区：
文献类型：
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作者：
Kalantar-Zadeh, K;Kopple, JD;Humphreys, MH
营养不良-炎症复合综合征（MICS）常见于维持性血液透析（MHD）患者，可能与发病率和死亡率增加相关。一个最佳的，全面的，定量的系统，评估MICS可能是一个有用的措施，临床状态，并可能是一个预测结果的MHD患者。因此，我们试图开发和验证这样一种工具，将其与营养和炎症的传统措施以及预期的住院和死亡率进行比较。使用传统的主观全面评估（SGA）的组成部分，一个半定量的规模与三个严重程度，透析营养不良评分（DMS），一个完全定量的评分系统，包括7个SGA组件，总评分范围7（正常）和35（严重营养不良），最近开发。为了改进DMS，我们在DMS的7个组成部分中加入了3个新元素：体重指数、血清白蛋白水平和总铁结合力，以代表血清转铁蛋白水平。这种新的综合营养不良-炎症评分（MIS）有10个组成部分，每个组成部分有4个严重程度，从0（正常）到3（非常严重）。所有10个MIS组件的总和范围为0 - 30，表示严重程度增加。将这些评分与人体测量、近红外测量的体脂百分比、包括血清C反应蛋白（CRP）在内的实验室测量以及12个月的前瞻性住院率和死亡率进行比较。在本研究开始时，对83例接受MHD治疗至少3个月（43 +/- 33个月）的门诊患者（44例男性，39例女性;年龄59 +/- 15岁）进行了评价，并随访1年。由经过培训的医生对所有患者同时进行SGA、DMS和MIS评估。住院天数（r = 0.45; P < 0.001）和住院频率（r = 0.46; P < 0.001）的MIS病例组合调整相关系数显著。与SGA和DMS相比，大多数相关系数与MIS更强。MIS，而不是SGA或DMS，与肌酐水平，红细胞压积，CRP水平显着相关。在12个月随访期间，9例患者死亡，6例患者离开队列。MIS每增加10个单位，考克斯比例风险计算的死亡相对风险为10.43（95%置信区间，2.28至47.64; P = 0.002）。MIS对死亡率的预测上级优于其组成部分或不同的亚版本。MIS似乎是一个综合评分系统，与MHD患者的预期住院率和死亡率以及营养、炎症和贫血指标显著相关。作为透析结果的预测指标和国家肾脏基金会2001年发布的MICS指标，MIS可能上级传统SGA和DMS以及个体实验室值。
Malnutrition inflammation complex syndrome (MICS) occurs commonly in maintenance hemodialysis (MHD) patients and may correlate with increased morbidity and mortality. An optimal, comprehensive, quantitative system that assesses MICS could be a useful measure of clinical status and may be a predictor of outcome in MHD patients. We therefore attempted to develop and validate such an instrument, comparing it with conventional measures of nutrition and inflammation, as well as prospective hospitalization and mortality. Using components of the conventional Subjective Global Assessment (SGA), a semiquantitative scale with three severity levels, the Dialysis Malnutrition Score (DMS), a fully quantitative scoring system consisting of 7 SGA components, with total score ranging between 7 (normal) and 35 (severely malnourished), was recently developed. To improve the DMS, we added three new elements to the 7 DMS components: body mass index, serum albumin level, and total iron-binding capacity to represent serum transferrin level. This new comprehensive Malnutrition-Inflammation Score (MIS) has 10 components, each with four levels of severity, from 0 (normal) to 3 (very severe). The sum of all 10 MIS components ranges from 0 to 30, denoting increasing degree of severity. These scores were compared with anthropometric measurements, near-infrared-measured body fat percentage, laboratory measures that included serum C-reactive protein (CRP), and 12-month prospective hospitalization and mortality rates. Eighty-three outpatients (44 men, 39 women; age, 59 +/- 15 years) on MHD therapy for at least 3 months (43 +/- 33 months) were evaluated at the beginning of this study and followed up for 1 year. The SGA, DMS, and MIS were assessed simultaneously on all patients by a trained physician. Case-mix-adjusted correlation coefficients for the MIS were significant for hospitalization days (r = 0.45; P < 0.001) and frequency of hospitalization (r = 0.46; P < 0.001). Compared with the SGA and DMS, most pertinent correlation coefficients were stronger with the MIS. The MIS, but not the SGA or DMS, correlated significantly with creatinine level, hematocrit, and CRP level. During the 12-month follow-up, 9 patients died and 6 patients left the cohort. The Cox proportional hazard-calculated relative risk for death for each 10-unit increase in the MIS was 10.43 (95% confidence interval, 2.28 to 47.64; P = 0.002). The MIS was superior to its components or different subversions for predicting mortality. The MIS appears to be a comprehensive scoring system with significant associations with prospective hospitalization and mortality, as well as measures of nutrition, inflammation, and anemia in MHD patients. The MIS may be superior to the conventional SGA and the DMS, as well as to individual laboratory values, as a predictor of dialysis outcome and an indicator of MICS. (C) 2001 by the National Kidney Foundation, Inc.