Bioelectric impedance body composition and phase angle in relation to 90-day adverse outcome in hospitalized COVID-19 ward and ICU patients: The prospective BIAC-19 study

Abstract

Background & Aims Gaining insight into readily obtainable baseline characteristics that allow prediction of adverse outcome in COVID-19 aids both treatment and healthcare planning. Bioelectric impedance (BIA) Phase Angle (PhA) is correlated with outcome in a multitude of diseases and may be of added value in predicting adverse outcome of COVID-19. We aimed to associate baseline body composition parameters with 90-day adverse outcome of COVID-19 including ICU-admission and to explore the added predictive value of baseline PhA. Methods We performed a prospective observational study, conducting BIA amongst COVID-19 patients within 24 hours of hospital admission, with a follow-up of 90 days. Data were compared between ward-only and ICU-patients. Regression models were used to assess the associations between baseline characteristics, body composition and 90-day adverse outcome, including a composite outcome score of morbidity, ICU-admission, and mortality. An ROC-curve was used to explore the added predictive value of PhA to other clinical parameters at baseline for the prediction of adverse outcome. Results One-hundred-and-fifty patients were included. Mean age was 68 (66-70) years, 67% were male. Forty-one (27%) patients were admitted to ICU and 77 (51%) met the criteria of the composite outcome score. In multiple regression, PhA was independently, inversely correlated with risk of ICU-admission (OR .531, p=.021), complications (OR .579, p=.031), hospital length of stay (OR .875, p=.037) and the composite outcome score (OR .502, p=.012). An ROC-curve showed that the incorporation of PhA in a composite risk-score improved the discriminative power for the composite outcome from poor to fair, compared to individual predictors (AUC 0.79 (95% CI 0.71-0.87). Conclusion BIA measurements including Phase Angle are independently correlated with an adverse outcome of COVID-19. Interpretation of Phase Angle can be a valuable addition to risk assessment of adverse outcome of COVID-19 at hospital admission. Clinical Trial Registration Netherlands Trial Register number NL8562, registered 2020-04-21.

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

“…Regarding LOS, a study with 150 ward and ICU patients found that greater PhA was associated with reduced hospital stay (OR = 0.875, P = 0.037), after adjusting for age, sex, and respiratory rate 23 . Similarly, the study with 67 patients who were critically ill showed a significant negative correlation between PhA and LOS ( r = −0.33, P = 0.03) 24 .…”

“…After reading titles and abstracts, 218 articles were excluded. This resulted in 11 articles to be read in full and, of these, only 7 met the eligibility criteria 22–28 …”

Poor Nutritional Status and Dynapenia Are Highly Prevalent in Post-Acute COVID-19

“…Directly measured raw BIA variables may be considered as indexes of BCM and ECW/TBW ratio; the interest in assessing PhA and IR is, therefore, justified by the idea to get additional information in the clinical setting on the inherent characteristics and composition of FFM (46,47). Low PhA has already been observed in hospitalized COVID-19 patients and related to disease severity and prognosis (10,48,49), with little evidence in post-acute COVID-19 (8,12) and no data on IRs, while abnormalities in both PhA and IRs have already been reported by our group in malnourished patients with chronic obstructive pulmonary disease (COPD) (50).…”

Protein requirements and provision in hospitalised COVID-19 ward and ICU patients: Agreement between calculations based on body weight and height, and measured bioimpedance lean body mass

“…For this post-hoc sub-study, baseline data previously collected for the prospective BIAC-19 study were used. The Bioelectric impedance body composition and phase angle concerning 90-day adverse outcome in hospitalised COVID-19 ward and ICU patients: the prospective BIAC-19 study aimed to associate baseline (<24 h of hospital admission) BIA body composition parameters with 90-day adverse outcome of COVID-19 [13]. The BIAC-19 study protocol has been registered in the Netherlands Trial Register (number NL8562).…”

“…We previously conducted a prospective observational study in which all hospitalised patients for COVID-19 underwent BIA measurements within 24 h of hospital admission [13]. The current posthoc study compares the agreement between LBM BIA and five mathematical methods in estimating LBM in this COVID-19 population.…”