Tian Rongrong, Chang Liyang, Cheng Linghong, Yang Ruchun, Zhang Hongmei
Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Nephrology Laboratory, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Ren Fail. 2025 Dec;47(1):2512405. doi: 10.1080/0886022X.2025.2512405. Epub 2025 Jun 4.
Malnutrition, inflammation, and fluid overload can reinforce each other, forming a detrimental syndrome in patients receiving hemodialysis (HD). However, this syndrome remains insufficiently recognized. This study aims to explore the relationship between the malnutrition-inflammation-fluid overload complex syndrome (MIFCS) and all-cause death.
A retrospective analysis was conducted. Malnutrition, inflammation, and fluid status were evaluated over a 4-month period, while all-cause mortality data were collected during a 7-year follow-up. Fluid status was evaluated using the extracellular water/total body water ratio (ECW/TBW), determined through bioelectrical impedance analysis (BIA). Nutritional status was assessed the modified creatinine index (mCI), while inflammation was assessed through high-sensitivity C-reactive protein (hs-CRP). The Cox proportional hazards model was applied to develop a nomogram model.
A total of 218 patients were included. The simultaneous presence of malnutrition, inflammation, and fluid overload (FO) was linked to the highest mortality risk (HR, 8.908; 95%CI, 2.986-26.575). A nomogram score based on MIFCS was developed to estimate survival probability at 3, 5, and 7 years. An increase in the nomogram score was progressively linked to an elevated mortality risk, with a hazard ratio of 1.399 (95%CI: 1.298-1.508, < 0.001) per 10-point increase.
MIFCS was significantly associated with an elevated mortality risk in HD patients. A comprehensive assessment of malnutrition, inflammation, and FO is essential for accurate prognostic assessment and risk stratification.
营养不良、炎症和液体过载可相互强化，在接受血液透析（HD）的患者中形成一种有害综合征。然而，这种综合征仍未得到充分认识。本研究旨在探讨营养不良-炎症-液体过载复合综合征（MIFCS）与全因死亡之间的关系。
进行回顾性分析。在4个月期间评估营养不良、炎症和液体状态，同时在7年随访期间收集全因死亡率数据。使用通过生物电阻抗分析（BIA）测定的细胞外水/总体水比率（ECW/TBW）评估液体状态。通过改良肌酐指数（mCI）评估营养状况，而通过高敏C反应蛋白（hs-CRP）评估炎症。应用Cox比例风险模型建立列线图模型。
共纳入218例患者。营养不良、炎症和液体过载（FO）同时存在与最高死亡风险相关（HR，8.908；95%CI，2.986-26.575）。基于MIFCS的列线图评分用于估计3年、5年和7年的生存概率。列线图评分的增加与死亡风险升高逐渐相关，每增加10分，风险比为1.399（95%CI：1.298-1.508，P<0.001）。
MIFCS与HD患者的死亡风险升高显著相关。对营养不良、炎症和FO进行全面评估对于准确的预后评估和风险分层至关重要。
