A Comparison of Systemic Inflammation-Based Prognostic Scores in Patients on Regular Hemodialysis

• Published in: Nephron extra 2013-10, Vol.3 (1), p.91-100
• Main Authors: Kato, Akihiko, Tsuji, Takayuki, Sakao, Yukitoshi, Ohashi, Naro, Yasuda, Hideo, Fujimoto, Taiki, Takita, Takako, Furuhashi, Mitsuyoshi, Kumagai, Hiromichi
• Format: Article
• Language: English
• Subjects: Original Paper
• ISSN: 1664-5529; 1664-5529
• DOI: 10.1159/000355148

Background/Aims: Systemic inflammation-based prognostic scores have prognostic power in patients with cancer, independently of tumor stage and site. Although inflammatory status is associated with mortality in hemodialysis (HD) patients, it remains to be determined as to whether these composite scores are useful in predicting clinical outcomes. Methods: We calculated the 6 prognostic scores [Glasgow prognostic score (GPS), modified GPS (mGPS), neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI)], which have been established as a useful scoring system in cancer patients. We enrolled 339 patients on regular HD (age: 64 ± 13 years; time on HD: 129 ± 114 months; males/females = 253/85) and followed them for 42 months. The area under the receiver-operating characteristics curve was used to determine which scoring system was more predictive of mortality. Results: Elevated GPS, mGPS, NLR, PLR, PI and PNI were all associated with total mortality, independent of covariates. If GPS was raised, mGPS, NLR, PLR and PI were also predictive of all-cause mortality and/or hospitalization. GPS and PNI were associated with poor nutritional status. Using overall mortality as an endpoint, the area under the curve (AUC) was significant for a GPS of 0.701 (95% CI: 0.637-0.765; p < 0.01) and for a PNI of 0.616 (95% CI: 0.553-0.768; p = 0.01). However, AUC for hypoalbuminemia (