Phase angle is associated with length of hospital stay, readmissions, mortality, and falls in patients hospitalized in internal-medicine wards: A retrospective cohort study

Giorno, Rosaria Del; Quarenghi, Massimo; Stefanelli, Kevyn; Rigamonti, Alice; Stanglini, Carlotta; Vecchi, Valentina De; Gabutti, Luca

doi:10.1016/j.nut.2020.111068

Cited by 21 publications

(18 citation statements)

References 46 publications

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“…Stapel et al reported similar results in a non-COVID-19 cohort of 196 critically ill patients (5.0 • in nonsurvivors vs 5.4 • ± 1.2 • in survivors; P ≤ .001) 25. Different studies have proposed the utility of BIA measurements such as PhA in predicting survival, nutrition status, and disease progression in several clinical conditions 27,28. Until this date, there are no data of PhA relation with nutrition status and clinical outcomes in critically ill patients with COVID-19.…”

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confidence: 75%

“…Different studies have proposed the utility of BIA measurements such as PhA in predicting survival, nutrition status, and disease progression in several clinical conditions. 27 , 28 Until this date, there are no data of PhA relation with nutrition status and clinical outcomes in critically ill patients with COVID‐19. However, some authors mark the importance of establishing a specific cutoff point for each clinical condition.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical ventilation, days, median (IQR)13(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Hospital length of stay, days, median (IQR) 20(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 60-day all-cause mortality, n (%) 25 (37.3) Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; BMI, body mass index; COVID-19, coronavirus disease 2019; IQR, interquartile range; NUTRIC, Nutrition Risk in the Critically Ill; SOFA, Sequential Organ Failure Assessment. TA B L E 2 Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; ECW/TBW, extracellular water/total body water ratio; NUTRIC, Nutrition Risk in the Critically Ill; SOFA, Sequential Organ Failure Assessment; SPA, standardized phase angle.…”

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confidence: 99%

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Low phase angle is associated with 60‐day mortality in critically ill patients with COVID‐19

Osuna-Padilla

Rodríguez-Moguel

Rodríguez-Llamazares

et al. 2021

J Parenter Enteral Nutr

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Background: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes.Survival analysis by PhA value was performed using Kaplan-Meier curves.Results: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85 • in females and <5.25 • in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. Conclusion:Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.

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confidence: 75%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Low phase angle is associated with 60‐day mortality in critically ill patients with COVID‐19

Osuna-Padilla

Rodríguez-Moguel

Rodríguez-Llamazares

et al. 2021

J Parenter Enteral Nutr

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“…One potential explanation of our results could be the longer hospital stay of the patients with lower SPhA caused by surgical and/or infectious complications ( 16 ). Furthermore, the underlying CKD-related and posttransplant inflammatory responses observed as increased ferritin—acute phase protein—levels and higher MIS scores reflected on impaired nutritional status.…”

Section: Discussionmentioning

confidence: 94%

Standardized Phase Angle for Predicting Nutritional Status of Hemodialysis Patients in the Early Period After Deceased Donor Kidney Transplantation

2022

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BackgroundThis study was designed to verify whether early posttransplant standardized phase angle (SPhA) determines nutrition status of hemodialysis patients in regard to different nutritional markers and predicts handgrip strength (HGS) 6 months after kidney transplantation.MethodsA total of 82 kidney transplant recipients on maintenance hemodialysis treatment entered the study. Nutritional status was evaluated before kidney transplantation, at the hospital discharge date, and 6 months after. We used bioelectrical impedance analysis (BIA), three different malnutrition screening tools, HGS, and anthropometric measurements. Demographic profiles and biochemical nutritional markers were collected. SPhA values, adjusted for age and BMI, were used in our study.ResultsIn the early posttransplant period, kidney transplant recipients lost muscle mass, gained fat mass, and developed mostly negative SPhA, accompanied by significantly lower albumin levels. The subjects with lower than median (<-1.46) SPhAdis [the SPhA (at discharge) adjusted for hospitalization time and the baseline SPhA] displayed lower values of albumin concentration (43.4 vs. 45.1 g/l, p = 0.010), hemoglobin (124 vs. 133 g/l, p = 0.016), GNRI (113 vs. 118, p = 0.041), and HGS (30 vs. 33 kg, p = 0.043). These patients had higher ferritin concentrations (420 vs. 258 mkmol/l, p = 0.026), longer inpatient stays (32 vs. 21 days, p < 0.001), and higher MIS scores (3 vs. 1, p = 0.001).ConclusionAt the moment of hospital discharge, lower than the median SPhA is related to protein-energy wasting, represented as lower concentrations of nutrition biomarkers and an active inflammatory response. Higher SPhA before kidney transplantation predicts HGS 6 months after kidney transplantation, especially in women.

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“…Thus, it is interesting to assess the nutrition risk of these patients during early hospitalization 10 . A method of assessing nutrition status that can be conducted at the bedside, quickly and noninvasively, is the measurement of the phase angle (PhA), obtained through bioelectrical impedance analysis (BIA) 11,12 . This parameter is calculated by the ratio between reactance ( X c ) and resistance ( R ) 13 .…”

Section: Introductionmentioning

confidence: 99%

Association between phase angle and adverse clinical outcomes in hospitalized patients with COVID‐19: A systematic review

et al. 2022

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Phase angle, obtained by bioelectrical impedance, is an indicator of cellular integrity and has been proposed as a prognostic parameter in patients who are critically ill. This systematic review aimed to evaluate the association between phase angle and adverse clinical outcomes in hospitalized patients with coronavirus disease–2019 (COVID‐19). An extensive literature search was performed in the MEDLINE/PubMed, Embase, and Web of Science databases, with interest in observational studies evaluating the association between phase angle and adverse clinical outcomes in individuals aged ≥18 years hospitalized with COVID‐19. Studies were independently selected by two reviewers, according to eligibility criteria. Subsequently, data were extracted and presented in a qualitative synthesis. The evaluation of the quality of the studies was performed according to the Newcastle‐Ottawa scale. The full methodology was published in PROSPERO (ID CRD42022306177). A total of 392 articles were identified, resulting in seven selected studies, of which six were prospective cohorts and one was retrospective. In the quality assessment, six studies obtained scores equal to or greater than seven, indicating a low risk of bias. A total of 750 participants composed the samples of the selected studies. Five studies reported an independent association between phase angle and adverse clinical outcomes during hospitalization for COVID‐19, with emphasis on prolonged hospitalization and mechanical ventilation and higher mortality in patients with a lower phase angle. Thus, phase angle measurement can be useful in the early identification of risks in patients hospitalized with COVID‐19, for the purpose of adequacy of clinical management.

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Phase angle is associated with length of hospital stay, readmissions, mortality, and falls in patients hospitalized in internal-medicine wards: A retrospective cohort study

Cited by 21 publications

References 46 publications

Low phase angle is associated with 60‐day mortality in critically ill patients with COVID‐19

Low phase angle is associated with 60‐day mortality in critically ill patients with COVID‐19

Standardized Phase Angle for Predicting Nutritional Status of Hemodialysis Patients in the Early Period After Deceased Donor Kidney Transplantation

Association between phase angle and adverse clinical outcomes in hospitalized patients with COVID‐19: A systematic review

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