Simplified nutritional and inflammatory indicators for long-term survival from all-cause mortality in maintenance...

To investigate superior prognostic accuracy for long-term survival from all-cause mortality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD).

Reviews of 2,859 ESRD patients on MHD were retrieved. The Geriatric Nutritional Risk Index (GNRI) and systemic immune inflammation index (SII) was utilized to develop a composite score of nutritional-systemic immune inflammation (N-SII). Primary endpoint was prognostic capability for long-term survival from all-cause mortality including cardiovascular events, cerebrovascular events, and infection episodes through an area under curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included optimal cut-off value and hazard ratio.

The composite scoring system of N-SII had a better prognostic accuracy for long-term survival from all-cause mortality in hemodialysis patients with a greater AUC of 0.850 (95% CI: 0.825 - 0.874) compared to either the isolated score of GNRI or SII (AUC = 0.761 (95% CI: 0.725 - 0.791) and 0.782 (95% CI: 0.767 - 0.826)) (p < 0.001). Superiority was met if the 95% CI fell within a superiority margin of 0.80. High-risk N-SII score was an independent predictor for all-cause mortality (HR = 2.049 (95% CI: 1.668 - 2.516)) with specificity and sensitivity of 0.784 and 0.899. A significantly shorter survival from all-cause death was observed in high-risk N-SII cohort as opposed to low-risk (44.14 (95% CI: 42.76 - 45.52) vs. 31.19 (95% CI: 28.50 - 33.89), p < 0.001).

The composite index of N-SII showed a superior prognostic accuracy for long-term survival from all-cause mortality as opposed to isolated GNRI or SII, highlighting the integration of nutritional and inflammatory indexes for effective risk stratification of prognostic assessment among patients on MHD.