Metabolic Vulnerability Index (MVX) Plus by NMR

Plasma (preferred) or serum

1 mL

0.5 mL (Note: This volume does not allow for repeat testing.)

Lavender-top (EDTA-no gel) tube (preferred) or green-top (sodium heparin) plasma tubes; plain red-top tube and NMR LipoTube (black-and-yellow-top tube) also are acceptable

Collect specimen in a lavender-top (EDTA-no gel) tube, which is the preferred specimen. Separate plasma from lavender-top (EDTA-no gel) tube immediately after collection. Plasma should then be transferred to a transport tube for storage at (2°C to 8°C) until time of shipment.

Separate plasma from green-top (sodium heparin) tube immediately after collection. Plasma should then be transferred to a transport tube for storage at (2°C to 8°C) until time of shipment.

For plain red-top tube, hold tube upright at room temperature for 45 minutes after drawing and allow to clot. Centrifuge specimen after clotting according to manufacturer's specifications. Transfer to a transport tube for storage at (2°C to 8°C) until shipped.

For NMR LipoTube (black-and-yellow-top tube), keep upright at room temperature for 30 minutes and allow to clot. Centrifuge at 1600 to 1800 xg for 10 to 15 minutes immediately after clotting. If the sample cannot be centrifuged immediately, it must be refrigerated at (2°C to 8°C and centrifuged within 24 hours of collection. The NMR tube should then be stored at (2°C to 8°C) until shipped.

All specimens should be shipped for testing within 48 hours of collection. Shipment should maintain (2°C to 8°C) storage conditions to maximize sample longevity. Frozen storage and/or fresh shipment of specimens are acceptable.

Refrigerate.

Fasting for 10 to 12 hours is preferred since there is a postprandial effect on MVX parameters that is not consistent or uniform and that depends on food and individual response.

Unspun LipoTube or unseparated plain red-top, EDTA or sodium heparin tube; serum or plasma specimens drawn in gel-barrier collection tubes other than the NMR LipoTubes

The Metabolic Vulnerability Index (MVX) is intended for use in adult subjects for the quantitative determination of a mortality risk score in serum or plasma. The MVX score (1-100) may be used as a prognostic aid for assessing comparative survival vulnerability stemming from metabolic dysfunction.

MMX measurements from plasma specimens are on average 10% to 15% higher than from serum specimens. IVX measurements from plasma specimens are on average 5% to 10% lower than from serum specimens. Therefore, MVX measurements from plasma specimens are on average 5% higher than from serum specimens. MVX results are increased 10% to 15% at hemoglobin concentrations higher than 123 mg/dL. IVX results are increased 10% to 20% at hemoglobin concentrations higher than 123 mg/dL. 

This test was developed and its performance characteristics determined by Labcorp. It has not been cleared or approved by the Food and Drug Administration.

The MVX test is a nuclear magnetic resonance spectroscopy (NMR)-derived multi-analyte algorithm that calculates a score based on the results of GlycA, citrate, branched- chain amino acids and small HDL particles from 400 MHz proton NMR spectra of serum or plasma samples. These analytes are used to produce the IVX, MMX and MVX scores.

The MVX test produces a multimarker score (MVX values 1-100) that is proportional to a patient's relative risk of all-cause death occurring in the approximate near term (within about 10 years), independent of age and other mortality risk factors. The MVX score is calculated from measured concentrations of six serum metabolites that are combined into two "sub-index" scores considered to reflect mainly the inflammatory and malnutrition elements of the intertwined metabolic malnutrition-inflammation syndrome. These "sub-index scores" are the Inflammation Vulnerability Index (IVX), derived from levels of GlycA and small HDL particles, and Metabolic Malnutrition Index (MMX), derived from levels of the three branched-chain amino acids (valine, leucine, isoleucine) and citrate.

MVX scores were associated with one-year and five-year mortality.^1,2 MVX scores are related to mortality risk irrespective of cause (e.g., CV death and non-CV death). Associations of MVX with all-cause mortality were similar in men and women and are independent of risk factors (e.g., BMI or age) that may affect five-year survival rates.¹ Clinical utility in high CVD-risk patients could be stratification of those who have the highest likelihood of survival vs. those who may need aggressive intervention.¹ Varying levels of IVX and MMX scores in different patients may help physicians choose personalized treatments (e.g., treatment of a patient with high IVX with an anti-inflammatory agent). 

Extending lifespan is among the overarching objectives of modern healthcare, which is organized around therapeutic areas that target the diseases and chronic conditions (including old age) that are the primary causes of death. Mitigating disease risk will unquestionably lower mortality risk, but a new concept is emerging that near-term survival, independent of disease status, is strongly influenced by previously unrecognized metabolic factors that make individual patients either relatively resilient or vulnerable. Described initially in the context of chronic kidney disease, and later in heart failure, liver disease, rheumatoid arthritis and cancer, excess mortality risk was attributed to a syndrome of combined muscle wasting, metabolic malnutrition and inflammation.^3,4 The reason there is so little awareness of the impact this malnutrition-inflammation syndrome has on mortality risk, and the therapeutic opportunities it offers to extend survival in those at high risk, is a lack of simple quantitative clinical assessment tools.⁵ The new MVX biomarker is intended to meet this need, both for prognostic purposes and to aid investigation of the efficacy and safety of potential therapeutic interventions. MVX is related to metabolic determinants of survival that are "downstream" of risk factors for the development of various diseases.¹

1. Otvos JD, Shalaurova I, May HT, et al. Multimarkers of metabolic malnutrition and inflammation and their association with mortality risk in cardiac catheterization patients: a prospective, longitudinal, observational cohort study. Lancet Healthy Longev. 2023 Feb;4(2):e72-e82. PubMed 36738747

2. Conners KM, Shearer JJ, Joo J, et al. The Metabolic Vulnerability Index: A novel marker for mortality prediction in heart failure. JACC Heart Fail. 2024 Feb;12(2):290-300. PubMed 37480881

3. Cederholm T, Jensen GL, Correira MITD, et al. GLIM criteria for the diagnosis of malnutrition – a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019 Feb;10(1):207-217. PubMed 30920778

4. Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients causes and consequences. Am J Kidney Dis. 2003 Nov;42(5):864-881. PubMed 14582032

5. Carriere I, Dupuy A-M, Lacrous A, Cristol J-P, Delcourt C, Pathologies Oculaires Liées à l'Age Study Group. Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people. J Am Geriatr Soc. 2008 May;56(5):840-846. PubMed 18410327