Low phase angle is associated with 60‐day mortality in critically ill patients with COVID‐19

Abstract

Background: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes.Survival analysis by PhA value was performed using Kaplan-Meier curves.Results: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85 • in females and <5.25 • in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. Conclusion:Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.

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

“…The demographics of our cohort are similar to those found in literature [1,3,12]. Although the average patient was overweight, body mass index was not different between the ICU and the wardonly group, in concordance with our previous findings [1].…”

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment

“…For those with a BMI !30 kg/m 2 , an SMI 54.3 cm 2 /m 2 for men and 46.6 cm 2 /m 2 for women was considered. The following surrogate markers were used for low mass identification: a) FFMI <17 kg/m 2 for males or <15 kg/m 2 in females [28,29], endorsed by the Global Leadership Initiative on Malnutrition (GLIM) consensus statement [30]; b) low sex-specific, BMI-adjusted CC was defined using Gonzalez et al references for males and females using 1 SDs below each mean [31]; c) low MUAC (<5th percentile) was defined based on an Mexican-American population (25.7 cm for females, 28 cm for males) [32], d) and low PhA values (<3.85 in females and <5.25 in males), as reported for COVID-19 critically ill patients [19].…”

“…Nevertheless, they lack accuracy, especially considering IV infusion therapy and fluid overload, which are treatments commonly observed in critically ill patients [15e17]. Despite its limitations, BIA also allows for the assessment of phase angle (PhA), which has been proposed as an indirect marker of muscle mass and quality, and a predictor of clinical outcomes [18,19].…”

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).…”

“…In addition, directly measured raw BIA variables (phase angle = PhA and impedance ratio = IR) yield information on inherent characteristics of FFM or muscle mass that may be related to body cell mass (BCM) and the ratio between extracellular water and total body water (ECW/TBW). Actually, low PhA has been observed in different categories of hospitalized COVID-19 patients and related to disease severity, length of stay, and mortality (9)(10)(11), with little evidence available in post-acute COVID-19 (8,12).…”