MALNUTRITION INFLAMMATION SCORE (M.I.S)
MIS SCORE is xxx. .
|
(A) Patient's related medical history:
1. Change in end dialysis dry weight (overall change in past 3-6 months): |
| 1 |
0 | 1 | 2 | 3 |
No decrease in dry
weight or weight
loss < 9.5 kg | Minor weight loss
(≥ 0.5 kg but < 1 kg) | Weight loss more
than 1 kg
but < 5% | weight loss >
5% |
2. Dietary Intake: |
| 2 |
0 | 1 | 2 | 3 |
Good appetite and
and no deterioration of
the dietary intake
pattern
| Somewhat sub-optimal
solid diet intake | Moderate overall
decrease to full
liquid diet | Hypo-caloric liquid
to starvation |
| 3. Gastrointestinal (GI) symptoms: |
| 3 |
0 | 1 | 2 | 3 |
No symptoms with
good appetite
| Mild symptoms, poor
appetite or nauseated
occasionally | Occasional vomiting
or moderate GI
symptoms | Frequent diarrhea
or vomiting or
severe anorexia |
| 4. Functional capacity (nutritionally related functional impairment):: |
4 |
0 | 1 | 2 | 3 |
Normal to improved
functional capacity,
feeling fine | Occasional difficulty
with baseline ambulation,
or feeling tired frequently | Difficulty with
otherwise independent
activities (e.g. going
to bathroom) | Bed/chair-ridden,
or little to no
physical activity |
5. Co-morbidity, including number of years on dialysis:
|
| 5 |
0 | 1 | 2 | 3 |
On dialysis < 1 year
and healthy otherwise
| Dialyzed for 1-4 years,
or mild co-morbidity
(excluding MCC*)
| Dialyzed > 4
years, or moderate
co-morbidity
(including one MCC*)
| Any severe, multiple
co-morbidity
(2 or more MCC*) |
(B) Physical Exam (according to SGA Crieteria):
6. Decreased fat stores or loss of subcutaneous fat (below eyes, triceps, biceps, chest):
|
| 6 |
0 | 1 | 2 | 3 |
| Normal (no change) | Mild | Moderate | Severe |
7. Signs of muscle wasting (temple, clavicle, scapula, ribs, quadriceps, knee, interosseous):
|
| 7 |
0 | 1 | 2 | 3 |
| Normal (no change) | Mild | Moderate | Severe |
(C) Body Mass Index:
8.Body mass index:Input BMI (if known) or leave blank and calculate below
BMI = Wt(kg) / Ht2(m).
Inches: Centimeters:
WEIGHT=wt kg. HEIGHT=ht m. BMI=bmi kg/m2.
|
| 8 |
0 | 1 | 2 | 3 |
| BMI ≥ 20 kg/m2 | BMI 18 - 19.99 kg/m2 | BMI 16 - 17.99 kg/m2
| BMI < 16 kg/m2 |
(D) Laboratory Parameters:
9. Serum albumin
|
| 9 |
0 | 1 | 2 | 3 |
| Albumin ≥ 4.0 g/dL
| Albumin 3.5 - 3.9 g/dL
| Albumin 3.0 - 3.4 g/dL
| Albumin < 3.0 g/dL |
10. Serum TIBC (Total Iron Binding Capacity) OR serum transferrin .
Input value |
| 10 |
0 | 1 | 2 | 3 |
TIBC ≥ 250 mg/dL
Transferrin > 200 mg/dL
| TIBC 200 -249 mg/dL
Transferrin 170 -200 mg/dL
| TIBC 150 -199 mg/dL
Transferrin 150 -169 mg/dL
| TIBC < 150 mg/dL
Transferrin < 150 mg/dL
|
MALNUTRITION INFLAMMATION SCORE: mis
|
*MCC (Major Comorbid Conditions): include CHF class III or IV, full blown AIDS
severe CAD, moderate to severe COPD, major neurologic sequelae,
and metastatic malignancies or s/p recent chemotherapy. |
| NOTES: n = 346 patients x = 6.3 SD = 3.9 25th%=4 50th% (median) = 5.5 75th% = 8 |
REFERENCE: Kalantar-Zadeh K, Kopple JD, Humphreys MH, Block G.
Comparing outcome predictability of markers of malnutrition-inflammation
complex sydrome in hemodialysis patients. Nephrol Dial Transplant (2004) 19:1507-1519
|