Abstract: 【Abstract】Objective To compare the accuracy of modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS) for the evaluation of nutritional status and the prediction of cardio- and cerebro-vascular events in elderly maintenance hemodialysis (MHD) patients. Methods A total of 236 MHD patients treated in the period from January 2014 to December 2016 were enrolled in this study. Patients were on MHD for more than 3 months and over 60 years old. MQSGA and MIS were performed for these patients. Clinical data and laboratory test results were collected. Body mass index (BMI), skin fold thickness of upper arm, skin fold thickness of triceps muscle, upper arm circumference and upper arm muscle circumference were measured. The correlation of these parameters with MQSGA and MS was analyzed. The effectiveness of MQSGA and MS for the evaluation of malnutrition-inflammation status was compared. Clinical data were compared between patients with cardio- and cerebro-vascular events and those without cardio- and cerebro-vascular events. Multivariate logistic regression was used to analyze the relationshipbetween the scores from different nutrition evaluation method and cardio- and cerebro-vascular events. Results This study enrolled 236 MHD patients (138 males and 108 females, average age 73.4±7.6 years, and MHD duration 35.1±14.2 months). The proportion of malnutrition in this cohort was 64.4% by MQSGA and was 65.8% by MIS (χ2=0.150, P=0.699). Except for the skin fold thickness of triceps muscle, the absolute values of correlation coefficient for nutrition and inflammatory indexes were higher from MIS than from MQSGA, suggesting that MIS is better than MQSGA for the evaluation of nutritional status in elderly MHD patients. The levels of MIS score (Z=2.641, P＜0.001), MQSGA (Z=2.012, P＜0.001), pre-albumin (t=2.951, P= 0.002), and C reactive protein (Z=2.715, P＜0.001) were significantly higher in patients with cardio- and cerebro-vascular events than in those without cardio- and cerebro-vascular events. Multivariate logistic regression showed that the relative risk (RR) of cardio- and cerebro-vascular events from MQSGA (RR=1.516, 95% CI 1.109-2.001, P=0.005) was significantly lower than that from MIS (RR=2.563, 95% CI 1.561～5.211, P=0.003), suggesting that MIS is more valuable than MQSGA in predicting the risk of cardio- and cerebro-vascular events in elderly MHD patients. Conclusion MIS was better than MQSGA for the evaluation of nutritional status and the prediction of cardiovascular events in elderly MHD patients.

Key words: Hemodialysis, elderly, malnutrition, MIS score, cardiovascular events