Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study

Denneman, Nadine; Hessels, Lara; Broens, Bo; Gjaltema, Jolijn; Stapel, Sandra N.; Stohlmann, Julius; Nijsten, Maarten W. N.; Straaten, Heleen M. Oudemans–van

doi:10.1038/s41430-020-0622-7

Cited by 22 publications

(22 citation statements)

References 30 publications

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“…In practice, PA indeed seems to vary with hydration. However, it remains a good indicator of clinical outcome, as fluid overload itself also negatively impacts outcome of disease, as was suggested by our findings [41,42,57].…”

Section: Limitations and Considerationssupporting

confidence: 58%

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

et al. 2021

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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.

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Section: Limitations and Considerationssupporting

confidence: 58%

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

et al. 2021

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“…The studies applying surrogates suffer the same shortcomings, but the poor quality assessment in these studies also concerns the risk of bias using a surrogate as a reference test instead of a gold standard. Several studies were rated as having a high risk of bias solely by this argument 8,27‐31 . The majority of studies had a low risk of bias regarding the flow and timing, meaning that measuring of the index and reference tests was conducted simultaneously.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies were rated as having a high risk of bias solely by this argument. 8,[27][28][29][30][31] The majority of studies had a low risk of bias regarding the flow and timing, meaning that measuring of the index and reference tests was conducted simultaneously. No overall concern of applicability regarding the choice of the index and reference tests was seen, except for one study applying inulin dilution with very sparse validation.…”

Section: Risk Of Biasmentioning

confidence: 99%

Bioimpedance as a measure of fluid status in critically ill patients: A systematic review

Madsen

Wichmann

Bestle

et al. 2021

Acta Anaesthesiol Scand

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Objective Precise measurements of fluid status lack valid methods. Bioimpedance is an attractive diagnostic tool because it is noninvasive, quick, and relatively cheap. This systematic review aims to assess the existing evidence of bioimpedance as an accurate measure of fluid status in critically ill patients. Data sources PubMed and Embase up till March 2021 were systematically searched (PROSPERO: CRD42020157436). Study selection Eligibility criteria were studies reporting original data from cohorts of adult patients in intensive care units and doing at least one whole‐body bioimpedance and one reference test. In addition, studies assessing internal reproducibility were included. Data extraction An extraction form was designed for the purpose. Data synthesis Nine hundred five studies were screened for eligibility, and 28 studies, comprising 1482 individual patients, were included in the final analysis. Eight studies compared bioimpedance with a gold standard, and two of those reported the results adequate. We found a low mean difference, but the 95% limits of agreements had wide limits. The remaining studies applied different surrogates as reference tests. Correlations ranged from 0.05 to 0.99. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence for all outcomes was very low. Conclusions The accuracy of bioimpedance as a measure for fluids in critically ill patients in the intensive care unit cannot be determined. Due to the lack of a gold standard, numerous studies compared bioimpedance with surrogate outcomes with great variability in both designs and results. Assessing the internal reproducibility of bioimpedance had the same limitations, but the studies overall reported good internal reproducibility.

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“…Additionally, the measurement using BIA usually takes less than two minutes as a non-invasive approach with a portable machine is suitable for an immobilized patient 4 , 21 , 22 . It could be also used safely for postoperative critical ill patients with poor clinical conditions such as bleeding without giving them time-related discomfort or any other risks of procedure.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of bioelectrical impedance analysis and ECW ratio as a guidance for fluid management in critically ill patients after operation

Chung

Kim

2021

Sci Rep

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We determined the relationship between changes in bioelectrical impedance analysis (BIA) parameters and response of critically ill patients to fluid therapy during early postoperative period. Associations between BIA values indicating volume status of postoperative patient and clinical outcomes were also evaluated. From May 2019 to April 2020, patients who were admitted to the surgical intensive care unit (SICU) of our institution at more than 48 h after surgery were enrolled. Volume status was measured with a portable BIA device every morning for five days from SICU admission. Overhydration was defined as the case where extracellular water (ECW) ratio > 0.390 measured by BIA. Participants were daily classified into an overhydration or a normohydration group. The relationship between daily hydration status and postoperative outcome was evaluated. Most of the 190 participants showed the overhydration status in the first 48 h after surgery. The overhydration status on day 3 was significant predictor of postoperative morbidities (OR 1.182) and in-hospital mortality (OR 2.040). SOFA score was significant factor of postoperative morbidities (OR 1.163) and in-hospital mortality (OR 3.151) except for the overhydration status on day 3. Cut-off values of overhydration status by ECW ratio at day 3 for predicting postoperative morbidities and in-hospital mortality were > 0.3985 and > 0.4145, respectively. BIA would be a useful and convenient tool to assess the volume status of patients requiring intensive fluid resuscitation in early postoperative period. Overhydration status by ECW ratio on postoperative day 3 needs careful monitoring and appropriate interventions to improve clinical outcomes.

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Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study

Abstract: Oudemans-van Straaten, H. M. (2020). Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study.

Cited by 22 publications

References 30 publications

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

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

Bioimpedance as a measure of fluid status in critically ill patients: A systematic review

Usefulness of bioelectrical impedance analysis and ECW ratio as a guidance for fluid management in critically ill patients after operation

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