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

OBJECTIVE: 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). MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.