Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project

Thibault, Ronan; Makhlouf, A; Mulliez, Aurélien; González, Marı́a Cristina; Kėkštas, Gintautas; Kozjek, Nada Rotovnik; Preiser, Jean‐Charles; Rozalen, I. Ceniceros; Dadet, S.; Krznarić, Željko; Kupczyk, Kinga; Tamion, Fabienne; Cano, Noël; Pichard, Claude; Graf, S.; Heidegger, Claudia Paula; Guerreiro, Márcio Osório; Orlandi, Silvana Paiva; Klimašauskas, Andrius; Sostakaite, Gintare; Gorjup, Kristina; Kogovšek, Katja; Pirtovšek, Katja Kopriva; Norrenberg, Michelle; Rizkallah, Karen; Wéry, François; Hssain, Ali Ait; Pereira, Bruno; Souweine, Bertrand; Grangé, Steven; Marchalot, Antoine; Bernier-Enguerrand, Pauline; Jakubczyk, Marlena; Różowicz, Aleksandra; Kłęk, Stanisław; Kunovic, Ana

doi:10.1007/s00134-016-4468-3

Cited by 121 publications

(132 citation statements)

References 35 publications

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“…Therefore, PA is closely related to health and nutrition status because it indicates both integrity of cellular membranes and water cellular distribution and is decreased in patients with significant weight loss . Given the close correlation between PA and nutrition status, it has been useful in clinical practice because it has enabled the identification of patients at risk of impaired nutrition status and decreased survival …”

Section: Discussionsupporting

confidence: 74%

“…Thus, BIA is not a good method for assessing body composition in situations where these 2 principles are not valid, such as with obesity, infants, and critically ill patients, and hydration disorders, such as ascites and edema . Conversely, BIA also provides an easy and quick PA measurement that reflects the FFM . PA is a nutrition marker obtained directly from BIA that is not subjected to prediction equations and does not suffer interference from hydration.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is 1 of the first in recent years to explore the use of nutrition indicators of body composition, particularly PA, as potential prognostic markers in critically ill children; it should be noted that Azevedo et al had already investigated the behavior of Xc and R in the severity of the critically ill pediatric patient, which was assessed by lung injury, sepsis severity, and multiple organ dysfunction . Thibault et al evaluated >900 adult patients and obtained results similar to ours. FFM measured at ICU admission by BIA‐derived PA was associated with 28‐day mortality, suggesting that this measure could be used as 1 of a battery of prognosis markers at ICU admission.…”

Section: Discussionmentioning

confidence: 99%

“…If we consider age as a PA‐determining factor and that PA values are inversely proportional to age, higher values would be expected in our pediatric population, denoting that the nutrition and health condition of these children was compromised. In fact, the cutoff we found in this pediatric population was lower than those found in the literature: 4.9 for adults with cirrhosis and 3.4 for critically ill adults …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Background Nutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid–upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. Methods Data from children aged 2 months–18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30‐day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan‐Meier method. Results We evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8° compared with patients with phase angle ≤2.8° (P < .0001). Kaplan‐Meier time‐to‐event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P = .003). Lower survival was also observed in patients who presented mid–upper arm circumference values ≤5th percentile (P < .03). Conclusions Mid–upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Low fat free mass as assessed by bioelectrical impedancederived phase angle was associated with clinical outcomes in various clinical conditions including cancer, liver cirrhosis or gastrointestinal surgical patients. In a study of 931 ICU patients, phase angle was lower on day 1 in survivors than in non-survivors [14]. Similarly, critically ill patients with low skeletal muscle quality assessed by CT-derived skeletal muscle density have heightened 6-month mortality [15].…”

mentioning

confidence: 98%

Focus on nutrition and glucose control in the intensive care unit: recent advances and debates

2017

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Optimization of Nutrition Therapy with the Use of Calorimetry to Determine and Control Energy Needs in Mechanically Ventilated Critically Ill Patients: The ONCA Study, a Randomized, Prospective Pilot Study

Gonzalez‐Granda

Schollenberger

Haap

et al. 2018

J Parenter Enteral Nutr

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Background Adequate nutrition therapy in critically ill patients poses a challenge because of the variable energy and substrate needs. The objective was to investigate whether nutrition therapy involving indirect calorimetry (IC), instead of equations for assessment of energy needs, could improve the nutrition status of critically ill patients. Methods Forty mechanically ventilated patients were randomized into a group in which energy needs were controlled by calorimetry (IC group) and a group treated with a formula‐based approach reflecting standard care (SC group). The primary outcome was change in the phase angle (PhA), a bioelectrical impedance parameter related to nutrition status and prognosis. Results The mean IC‐based energy requirement was lower than the formula‐based estimate (21.1 ± 6.4 versus [vs] 25 kcal/kg/d, P < .01). The IC group reached 98% ± 8% of the energy goal, whereas the SC group reached only 79% ± 29% (P < 0.05), although mean intake was similar in both groups. The protein intake goal was better met in the IC group (91% ± 24%) than the SC group (73% ± 33%). The PhA of the IC group did not change during treatment, whereas that of the SC group tended to decrease by 0.36° ± 0.86° (P = .077). A shorter length of stay in intensive care was observed in the IC than in the SC group (13 ± 8 vs 24 ± 20 days, P < .05). Conclusion Intensified individual nutrition therapy involving IC appears to be useful for improving nutrition status in critically ill patients.

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Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project

Abstract: NCT01907347 ( http://www.clinicaltrials.gov ).

Cited by 121 publications

References 35 publications

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

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

Focus on nutrition and glucose control in the intensive care unit: recent advances and debates

Optimization of Nutrition Therapy with the Use of Calorimetry to Determine and Control Energy Needs in Mechanically Ventilated Critically Ill Patients: The ONCA Study, a Randomized, Prospective Pilot Study

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