Association of bioelectric impedance analysis body composition and disease severity in COVID-19 hospital ward and ICU patients: The BIAC-19 study

Abstract

Background: The current severe acute respiratory syndrome coronavirus 2 pandemic is unprecedented in its impact. It is essential to shed light on patient characteristics that predispose to a more severe disease course. Obesity, defined as a BMI>30 kg/m 2 , is suggested to be one of these characteristics. However, BMI does not differentiate between fat mass and lean body mass, or the distribution of fat tissue. The aim of the present study was to assess the body composition of COVID-19 patients admitted to the ward or the ICU and identify any associations with severity of disease. Methods: We performed an observational cross-sectional cohort study. Bioelectric impedance analysis was conducted amongst all confirmed COVID-19 patients admitted to the ward or ICU of our hospital in the Netherlands, between April 10 and 17, 2020. Body water measurements and derived values were recalculated to dry weight, using a standard ratio of extracellular water to total body water of 0.38. Data were compared between the ward and ICU patients, and regression models were used to assess the associations between baseline characteristics, body composition, and several indicators of disease severity, including a composite score composed of mortality, morbidity, and ICU admission. Results: Fifty-four patients were included, of which 30 in the ward and 24 in the ICU. The mean age was 67 years (95%-CI 64e71), and 34 (63%) were male. Mean BMI was 29.7 (95%-CI 28.2e31.1) kg/m 2 and did not differ between groups. Body composition values were not independently associated with disease severity. In multiple logistic regression analyses, a low phase angle was associated with COVID-19 severity in the composite score (OR 0.299, p ¼ 0.046). Conclusion: We found no significant associations between body composition, including fat mass, visceral fat area, and fat-free mass, and disease severity in our population of generally overweight COVID-19 patients. A lower phase angle did increase the odds of severe COVID-19. We believe that factors other than body composition play a more critical role in the development of severe COVID-19.

Phase angle and standardized phase angle from bioelectrical impedance measurements as a prognostic factor for mortality at 90 days in patients with COVID-19: A longitudinal cohort study

“…Our observations are consistent with the initial finding of Moonen et al [17], who reported a direct relationship between mortality and PhA in critical patients with COVID-19 but did not determine the cut-off point of PhA as a predictor of mortality. Our results extend this observation and overcome the limitations of limited sample size and short follow-up (28 d) by developing survival curves and PhA cut-off points to predict mortality [17]. Importantly, we demonstrate that a cut-off PhA value (by ROC curve of survival) less than 3.95 is more sensitive prognostic factor in predicting mortality in COVID-19 patients than standard biochemical measurements of inflammation (Table 3, Fig.…”

“…PhA and SPhA are BIA measurements that are novel options for practical assessment and clinical evaluation of impaired nutritional status and prognosis among hospitalized COVID-19 patients and could potentially contribute to enhanced patient care and clinical outcomes. A recent observational cross-sectional cohort study reported that a lower PhA increased the odds of severe COVID-19 and mortality during a 28-d period [17]. Thus, there is a need to determine the prognostic value of PhA and SPhA among COVID-19 patients during acute infection.…”

Coronavirus Disease 19 from the Perspective of Ageing with Focus on Nutritional Status and Nutrition Management—A Narrative Review

“…To date, only a few studies have reported on body composition (BC) in COVID-19 patients [ 27 , 28 , 29 ]. In an observational and cross-sectional cohort study from the Netherlands, 54 patients, 30 in the ward and 24 in the Intensive Care Unit (ICU), were investigated.…”

“…BC was evaluated with bioelectric impedance (BIA). No differences were found related to BC, including fat mass, visceral fat area, and fat-free mass, nor were differences in disease severity found between those at the ward and those in the ICU [ 27 ]. However, according to the BMI data, the population was quite homogeneous.…”

“…It is sensitive to fluid overload and disturbances in the distribution of extra- and intracellular water [ 30 ]. Interestingly, a lower phase angle was associated with increased odds of severe COVID-19 [ 27 ]. Phase angle uses raw impedance data and provides information on hydration status, body cell mass, and cell integrity, without algorithm-inherent errors or assumptions such as constant tissue hydration.…”