Phase angle obtained by bioelectrical impedance analysis independently predicts mortality in patients with cirrhosis

Abstract

AIMTo evaluate the prognostic value of the phase angle (PA) obtained from bioelectrical impedance analysis (BIA) for mortality prediction in patients with cirrhosis.METHODSIn total, 134 male cirrhotic patients prospectively completed clinical evaluations and nutritional assessment by BIA to obtain PAs during a 36-mo follow-up period. Mortality risk was analyzed by applying the PA cutoff point recently proposed as a malnutrition marker (PA ≤ 4.9°) in Kaplan-Meier curves and multivariate Cox regression models.RESULTSThe patients were divided into two groups according to the PA cutoff value (PA > 4.9°, n = 73; PA ≤ 4.9°, n = 61). Weight, height, and body mass index were similar in both groups, but patients with PAs > 4.9° were younger and had higher mid-arm muscle circumference, albumin, and handgrip-strength values and lower severe ascites and encephalopathy incidences, interleukin (IL)-6/IL-10 ratios and C-reactive protein levels than did patients with PAs ≤ 4.9° (P ≤ 0.05). Forty-eight (35.80%) patients died due to cirrhosis, with a median of 18 mo (interquartile range, 3.3-25.6 mo) follow-up until death. Thirty-one (64.60%) of these patients were from the PA ≤ 4.9° group. PA ≤ 4.9° significantly and independently affected the mortality model adjusted for Model for End-Stage Liver Disease score and age (hazard ratio = 2.05, 95%CI: 1.11-3.77, P = 0.021). In addition, Kaplan-Meier curves showed that patients with PAs ≤ 4.9° were significantly more likely to die.CONCLUSIONIn male patients with cirrhosis, the PA ≤ 4.9° cutoff was associated independently with mortality and identified patients with worse metabolic, nutritional, and disease progression profiles. The PA may be a useful and reliable bedside tool to evaluate prognosis in cirrhosis.

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

“…The association between undernutrition and morbidity and mortality is known and widely documented in the adult population 7,25,26,34,[41][42][43][44][45] ; however, there is a lack of literature that demonstrates this association, evaluated particularly by body composition indicators, in sick and critically ill children. Thus, despite having several limitations, our study reinforces the importance of nutrition assessments in critically ill children and suggests that body composition may be useful not only for nutrition diagnosis and monitoring, but also for an additional indicator in estimating death risk and PICU LOS in this population.…”

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

“…PMT as an alternative indicator to assess for sarcopenia has also been proposed, but it requires further validation . Use of cross‐sectional CT/MRI, segmental DEXA using appendicular measures, and phase angle BIA have been shown to be less influenced by overhydration than whole body measures . Although ascites may be a confounding factor in determinations of SMM, recent studies indicate that total body fluid status rather than the presence of ascites may be the determining factor .…”

“…Although ascites may be a confounding factor in determinations of SMM, recent studies indicate that total body fluid status rather than the presence of ascites may be the determining factor . Although DEXA and BIA have been reported to overestimate muscle mass due to the assumption of constant tissue hydration, use of these methods may be clinically warranted to assess for sarcopenia when CT/MRI are unavailable . MRI, in particular, confers the added benefit of no radiation exposure .…”

“…(32) Use of cross-sectional CT/MRI, segmental DEXA using appendicular measures, and phase angle BIA have been shown to be less influenced by overhydration than whole body measures. (50)(51)(52) Although ascites may be a confounding factor in determinations of SMM, recent studies indicate that total body fluid status rather than the presence of ascites may be the determining factor. (49) Although DEXA and BIA have been reported to overestimate muscle mass due to the assumption of constant tissue hydration, use of these methods may be clinically warranted to assess for sarcopenia when CT/MRI are unavailable.…”

“…(49) Although DEXA and BIA have been reported to overestimate muscle mass due to the assumption of constant tissue hydration, use of these methods may be clinically warranted to assess for sarcopenia when CT/MRI are unavailable. (46,51,53) MRI, in particular, confers the added benefit of no radiation exposure. (46) In children, exposure to additional radiation imposed by a DEXA scan and the requirement for sedation in young children (<3 years) may outweigh the benefits of using DEXA to measure SMM.…”