Prognostic value of combined preoperative phase angle and handgrip strength in cardiac surgery

Abstract

Objectives Phase angle (PA) constitutes a bioelectrical impedance measurement, indicating cell membrane health and integrity, hydration, and nutritional status. Handgrip strength (HS) has been also associated with body composition, nutritional status, inflammation, and functional ability in several chronic diseases. Although their prognostic significance as independent biomarkers has been already investigated regarding the outcomes of a cardiac surgery, our study is the first one to assess the combined predictive value of preoperative PA and HS. Design and methods HS and PA measurements were performed preoperativelyin 195 patients undergoing cardiac surgery. The association ofthe combination of HS and PAwith all-cause mortality rates was the primary study outcome, while its association with the intensive care unit (ICU) length of stay (LOS) was the secondary one. Results PA was positively correlated with HS (r = 0.446, p < 0.005) and negatively with EuroSCORE II (r = − 0.306 p < 0.005). The combination of PA < 5.15 and HS < 25.5 was associated with higher one-year all-cause mortality (OR = 9.28; 95% CI 2.50–34.45; p = 0.001) compared to patients with PA > 5.15 and HS > 25.5, respectively. Patients with combined lower values of PA and HS (PA < 5.15 and HS < 30.7) were at higher risk of prolonged ICU LOS (OR = 4.02; 95% CI 1.53–10.56; p = 0.005) compared to those with higher PA–HS (PA > 5.15–HS > 30.7). The combination of PA–HS was also significantly linked with EuroSCORE II. Conclusion The combination of low preoperative PA and HS values was significantly associated with higher risk of all-cause mortality at 12 months and prolonged ICU LOS; thereby it might serve as a clinically useful prognostic biomarker after cardiac surgery procedures.

Variations in phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study

“…As a risk predictor, age had the greatest impact on HGS in both sexes. No studies in the literature have evaluated the values of HGS and PA over 12 months after cardiac surgery, just in preoperative or first week PO 6,16,17 …”

“…6,16,17 Some studies have evaluated HGS and PA as surgery outcome predictors. 16,17,23,30,36,40 A study that evaluated preoperative HGS in cardiac surgery patients found that a low preoperative HGS (<85% of age-sex standardized HGS) was associated with an increased risk of prolonged mechanical ventilation (≥12 h) (adjusted OR = 1.7 [95% CI = 1.0-2.8; P = 0.041]). 40 The lack of data in the literature on HGS cutoff points for these patients compared with healthy individuals limits interpretation of this study.…”

“…Calculated by a mathematical formula (PA = tangent arc reactance/ resistance), 11 it reflects changes in cellular membrane integrity and alterations in fluid balance. 12,13 It has been used as a prognostic indicator in several clinical situations, such as in critically ill, 14 cardiac, [15][16][17] cancer patients, 18 among others. 19,20 HGS is a useful test of functional capacity for assessing muscle strength in clinical and epidemiological studies.…”

Assessment of qualitative body composition, including phase angle, in the context of primary prevention and secondary prevention of cardiovascular diseases (cardiac rehabilitation)

“…Phase angle assessment has also found its way into cardiac surgery. Assessing PhA by BIA and handgrip strength in patients before cardiac surgery, Panagidi et al [48] found a positive correlation of PhA with handgrip strength (HS) (p < 0.005) and a negative correlation with the European System for Cardiac Opera-Med Pr Work Health Saf. 2024;75 (3) tive Risk Evaluation II score (p < 0.005), which assesses the risk of death after cardiac surgery.…”

Can resistance prehabilitation training bring additional benefits in valvular cardiac surgery? protocol for a randomized controlled trial

“…This condition has a pronounced impact on peripheral musculature. Research indicates that lower preoperative muscle density is associated with increased postoperative mortality rates [19][20][21] and a higher likelihood of pulmonary complications [20,[22][23][24]. Additionally, reduced manual grip strength correlates with higher mortality, longer hospital stays, and increased risk of postoperative complications [21,23,24].…”