Correlation Between MIS And Prognosis In Patients With Maintenance Hemodialysis

Objective: To evaluate malnutrition and microinflammation status in patients with maintenance hemodialysis(MHD)based on malnutrition inflammatory score(MIS),and to analyze its correlation with cardiac ultrasound index,hospitalization rate and mortality rate,so as to provide a scientific basis for improving the quality of life and survival rate of MHD patients.Methods:143 patients who met the selection criteria ≥3 months of hemodialysis treatment in the blood purification center of the affiliated hospital of Yan’an University from December 2017 to February 2020 were collected,of which 5 were transferred out(excluding death),and a total of 138 were included.The general data of the subjects were collected: including name,sex,age,blood pressure,primary disease,dialysis access,dialysis time.Anthropometric measures: including weight,height,body mass index(BMI),thickness of skin foid at triceps humerus(TSF),middle arm circumference(MAC),middle arm muscle circumference(MAMC).Blood biochemical index: including hemoglobin(Hb),prealbumin(PA),albumin(ALB),total protein(TP),intact parathyroid hormone(iPTH),total iron binding capacity(TIBC),calcium(Ca),phosphorus(P),calcium-phosphorus product(CaxP),urea(Urea),serumcreatinine(Scr),beta2-microglobulin(β2-MG),triglyceride(TG),total cholestero(TC),low-density lipoprotein cholesterol(LDL-C),c-reactive protein(CRP).Cardiac ultrasound indicators: including left ventricular end-diastolic diameter(LVDD),ventricular septal thickness(IVST),posterior wall thickness(PWI),ejection fraction(EF),ratio of early-diastolic to late-diastolic peak flow rate(E/A),left ventricular mass index(LVMI).Incidence of hospitalization and death: hospitalization and non-hospitalization,death and survival,calculation of hospitalization and mortality.The subjects were divided into mild malnutrition group(0<MIS≤4),moderate malnutrition group(5≤MIS≤8)and severe malnutrition group(MIS>8)according to the results of the MIS score.To analyze the composition of the general data of the subjects;A χ~2 test,rank sum test and variance analysis were used to analyze the correlation between malnutrition degree and clinical indexes;A χ~2 test and rank sum test were used to analyze the correlation between the degree of malnutrition and cardiac ultrasound indicators;A χ~2 test was used to analyze the correlation between the degree of malnutrition and hospitalization rate and mortality;Independent risk factors of death were analyzed and multivariate Logistic regression analysis was used.Results: 1.After MIS score,48 cases(34.3%)in mild group,60 cases(42.9%)in moderate group and 30 cases(21.4%)in severe group;The minimum age of 21 and the maximum age of 86,with an average age(51.56±14.52);Of these,97 were males(70.3%)and 41 females(29.7%);The primary diseases were 78 cases of chronic nephritis(56.5%),51 cases of diabetic nephropathy(37.0%),3 cases of hypertensive renal impairment(2.2%)and 4 cases(2.8%);There were 94 cases of autogenous arteriovenous fistula(68.1%),42 cases of central venous catheterization(30.4%)and 2 cases of transplantation(1.4%);The number of left ventricular hypertrophy was 71(50.7%)and 67(47.9%);All patients in the group were hospitalized in 56 cases within 12 months of the observation period,with a hospitalization rate of 40.6%,18 deaths and a mortality rate of 13.0%.2.The proportion of male,diabetic nephropathy,age and BMI、TSF、MAC、MAMC among the three groups of malnutrition were statistically significant(P<0.01).There was no significant difference in dialysis time and mean arterial pressure between the three groups(P>0.05).In terms of sex,the proportion of men in the three groups was lower in the mild group(70.8%)and the moderate group(66.6%)than in the severe group(76.6%);The proportion of diabetic nephropathy in mild group(31.2%)was lower than that in moderate group(43.3%)and severe group(33.3%);In age,mild group was lower than moderate group and severe group;As the degree of malnutrition increased,the level of BMI、TSF、MAC、MAMC between the three groups decreased.3.There was significant difference between the three groups Hb、ALB、TP、PA、iPTH、P、TIBC、Urea、Scr、CRP mild,moderate and heavy malnutrition(P<0.05).There was no significant difference in Ca、CaxP、β2-MG、TG、TC、LDL-C between the three groups(P>0.05).With the increase of malnutrition,the Hb、ALB、TP、PA、P、TIBC、Urea、Scr level decreased and the CRP level increased;iPTH levels were higher in both mild and moderate groups than in severe groups.4.There was significant difference between the three groups LVDD、IVST、PWI、LVMI mild,moderate and heavy malnutrition(P<0.05).Differences in cardiac valve calcification and left ventricular hypertrophy between the three groups were statistically significant(P<0.01).There was no significant difference in EF、E/A between the three groups(P>0.05).With the increase of malnutrition,the LVDD、LVMI level increased,and the IVST level of mild group was lower than that of moderate group and severe group;PWI of mild group and moderate group was higher than that of severe group;The higher the degree of malnutrition,the higher the proportion of left ventricular hypertrophy and cardiac valve calcification.5.A statistically significant difference was found in the hospitalization rate and mortality rate between the two groups(P<0.01);A statistically significant difference was found between two groups with mild,moderate and heavy malnutrition(P<0.01);The higher the degree of malnutrition,the higher the hospitalization rate and mortality rate.6.There were significant differences in age,sex,proportion of diabetic nephropathy and TSF、MAC、MAMC、BMI、TP、PA、HB、iPTH、CRP、MIS、LVMI between death and survival groups(P<0.05).In age,the death group was older than the survival group;In terms of sex,the proportion of men in death group(72.2%)was higher than that in survival group(70.0%);In diabetic nephropathy,the proportion of diabetic nephropathy in death group(27.7%)was lower than that in survival group(38.3%);The TSF、MAC、MAMC、BMI、TP、PA、HB、iPTH and CRP、MIS、LVMI levels of the patients in the death group were lower than those in the survival group.Multivariate Logistic regression analysis revealed that MIS(OR =1.827,95%1.388-2.405)and CRP(OR =1.843,95%1.162-2.923)were independent risk factors for the occurrence of death events.MIS risk of death for MHD patients will increase by 1.827 times for each unit promoted;CRP for each unit promoted,the risk of death for MHD patients will increase by 1.843 times.Conclusions:1.When using MIS to assess MHD patients with malnutrition,malnutrition is common in the patients.2.MIS is associated with the microinflammatory state in MHD patients,and the higher the degree of MIS,the higher the level CRP inflammatory factors.3.Proportion of left ventricular hypertrophy in the study population was 50.7%,the higher the degree of MIS,the higher the proportion of left ventricular hypertrophy and cardiac valve calcification.4.One-year survival rate MHD patients in this study population was 87.0% and the mortality rate was 13.0%.5.The higher the MIS of MHD patients the higher the hospitalization rate and mortality rate.6.MIS,CRP is an independent risk factor for death in MHD patients.