A New Index on Malnutrition: The Advanced Lung Cancer Inflammation Index and Its Relation to Mortality in Chronic Kidney Disease

Abstract

Objective: Malnutrition is a complication of chronic kidney disease (CKD) that contributes to poor survival. The Advanced Lung Cancer Inflammation Index (ALI) was designed to assess systemic inflammation in patients with metastatic cell lung cancer. The Geriatric Nutritional Risk Index (GNRI) was shown to predict mortality in patients undergoing dialysis. Considering the role of inflammation and malnutrition in mortality, this study aimed to investigate the relationship between a new index, ALI, in concordance with GNRI, and mortality in HD and PD patients. Methods: Patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD) at our institution between February 2012 and October 2022 were studied retrospectively. Advanced Lung Cancer Inflammation Index and GNRI were calculated by recommended formulas. The primary outcome was all-cause mortality. Results: A total of 176 patients (88 with HD and 88 with PD) were included in the study. The mean age was 50 ± 16 years. In receiver operating characteristic analysis for ALI, the best cutoff value was 36.9 to predict mortality with a sensitivity of 88% and specificity of 72.8%, and the area under the curve was 0.850 (95% CI, 0.763-0.937; P < .005) in HD patients and 37.2 to predict mortality with a sensitivity of 88% and specificity of 67.1 %, and the area under the curve was 0.832 (95% CI: 0.729-0.934; P < .005) in PD patients. In the Cox regression analysis, the major factors affecting mortality were age, C-reactive protein level, ALI, and GNRI. Conclusion: The nutritional risk assessment measures, GNRI and ALI, predict mortality in CKD patients.