The Malnutrition-Inflammation Score (MIS) can be used to evaluate patients who are receiving maintenance hemodialysis. This measures both the protein-energy malnutrition and inflammation prevalent in patients with end-stage renal disease. The authors are from UCLA Medical Center and UCSF General Hospital.
Parameters from medical history:
(1) change in end dialysis dry weight (overall change over the past 3 to 6 months)
(2) dietary intake
(3) gastrointestinal symptoms
(4) functional capacity (nutritionally-related functional impairment)
(5) co-morbidity (including number of years of dialysis)
Parameters from physical examination and Subjective Global Assessment:
(6) decreased fat stores or loss of subcutaneous fat
(7) signs of muscle wasting
(8) body mass index (body weight in kilograms, divided by height in meters squared)
Parameters from laboratory testing:
(9) serum albumin
(10) serum total iron binding capacity (TIBC)
where:
• Decreased fat is assessed below the eyes, about the upper arm (triceps, biceps) and chest.
• Muscle wasting may be observed over the clavicles, temple, scapula, ribs, quadriceps, knee and interosseous.
• Serum transferrin may be used as an alternative to the TIBC.
|
Parameter |
Finding |
Points |
|
change in end dialysis dry weight |
no decrease in dry weight; or weight loss < 0.5 kg |
0 |
|
|
minor weight loss (>= 0.5 to < 1 kg) |
1 |
|
|
weight loss >= 1 kg but < 5% |
2 |
|
|
weight loss > 5% |
3 |
|
dietary intake |
good appetite; no deterioration of the dietary intake pattern |
0 |
|
|
somewhat sub-optimal solid diet intake |
1 |
|
|
moderate overall decrease in solid diet intake to full liquid diet |
2 |
|
|
hypo-caloric liquid diet, or starvation |
3 |
|
GI symptoms |
none, with good appetite |
0 |
|
|
mild GI symptoms, with poor appetite or nauseated occasionally |
1 |
|
|
moderate GI symptoms, or occasional vomiting |
2 |
|
|
severe GI symptoms, with frequent diarrhea or vomiting or severe anorexia |
3 |
|
functional capacity |
normal to improved functional capacity; feeling fine |
0 |
|
|
occasional difficulty with baseline ambulation; feeling tired frequently |
1 |
|
|
difficulty with activities of daily living (ADL) |
2 |
|
|
bed or chair bound; minimal or no physical activity |
3 |
|
co-morbid conditions |
on dialysis less than 1 year; healthy otherwise |
0 |
|
|
on dialysis 1-4 years, or mild comorbidity with no major comorbid conditions |
1 |
|
|
on dialysis > 4 years, or moderate comorbidity with 1 major comorbid condition |
2 |
|
|
any severe, multiple comorbidity (>= 2 major comorbid conditions) |
3 |
|
decreased fat |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
muscle wasting |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
body mass index |
>= 20 kg per square meter |
0 |
|
|
18 – 19.99 kg per square meter |
1 |
|
|
16 – 17.99 kg per square meter |
2 |
|
|
< 16 kg per square meter |
3 |
|
serum albumin |
>= 4.0 g/dL |
0 |
|
|
3.5 – 3.9 g/dL |
1 |
|
|
3.0 – 3.4 g/dL |
2 |
|
|
< 3.0 g/dL |
3 |
|
serum TIBC |
>= 250 µg/dL |
0 |
|
|
200 – 249 µg/dL |
1 |
|
|
150 – 199 µg/dL |
2 |
|
|
< 150 µg/dL |
3 |
where:
• Major comorbid conditions: congestive heart failure class III or IV; full blown AIDS; severe coronary artery disease; moderate to severe COPD; major neurologic sequelae; metastatic malignancy; recent chemotherapy for malignancy.
• The normal ranges for serum albumin, serum TIBC and serum transferrin were not specified.
• The table gives serum TIBC in mg/dL, but according to Tietz's Clinical Guide to Laboratory Tests the units should be µg/dL.
• If serum transferrin is used instead of the serum TIBC, 0 points are assigned for >= 200 mg/dL; 1 point for 170 – 199 mg/dL; 2 points for 140 – 169 mg/dL; and 3 points if < 140 mg/dL.
malnutrition-inflammation score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 30
• The higher the score, the more severe the level of malnutrition and inflammatory change.
• The higher the score, the greater the risk for morbidity and mortality in a patient.
Specialty: Nutrition, Nephrology
