Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach

Abstract

Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9–89.3) vs. 73.7% (73.2–82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59–0.75) vs. 0.54 (0.48–0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459–6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664–3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906–10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375–2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.

Assessment of body composition in adults hospitalized with acute COVID-19: a scoping review

“…Regarding the year of publication, eight studies were published in 2020 ( 17 , 34 – 40 ), 29 in 2021 ( 6 , 7 , 15 , 16 , 18 – 22 , 28 , 30 , 31 , 41 – 57 ), and 18 in 2022 ( 9 , 23 – 27 , 29 , 32 , 33 , 58 – 66 ). Interestingly, the highest frequency of studies evaluating BC were from the European continent, with 37 studies (67.3%), followed by America with 13 publications (23.6%), Asia with four studies (7.3%), and Eurasia with one study ( Table 1 ).…”

“…Out of the 55 studies, 40 were single-center (72.7%) ( 6 , 9 , 17 – 23 , 25 , 27 , 28 , 30 – 32 , 34 , 36 , 38 , 42 , 43 , 45 – 50 , 52 , 53 – 55 , 58 , 60 – 66 ) and seven were multicenter cohorts (12.7%) ( 15 , 26 , 37 , 44 , 51 , 56 , 59 ); the remaining eight studies did not specify the number of centers (14.6%) ( 7 , 16 , 24 , 29 , 33 , 35 , 41 , 57 ). Most of the studies ( n = 46; 83.6%) investigated the associations between abnormal BC markers and changes with COVID-19 outcomes such as ICU admission, disease severity, length of hospital stay (LOS), mechanical ventilation (MV), and death ( 6 , 7 , 15 – 25 , 28 , 30 – 34 , 36 – 38 , 40 – 43 , 45 – 49 , 50 , 52 – 54 , 56 – 62 , 66 ).…”

Total and segmental phase angle in a cohort of hospitalised patients with COVID-19: mortality prediction and changes throughout hospitalisation

“…This can be interpreted as a decrease in body muscle mass and an increase in the patient’s fluid levels, which have been associated with functional deterioration and an increased risk of various clinical outcomes, including mortality, as Cornejo-Pareja et al, and Samoni et al found. Cornejo-Pareja et al showed that in patients with COVID-19, overhydration is related to mortality risk after ninety days ( 37 ) and Samoni et al reported that in patients from the ICU, the changes in body fluids to overhydration after five days also lead to higher mortality risk ( 38 ) . This can be explained because overhydration is the result of an imbalance where extracellular water is increased more than intracellular water; when this occurs, the balance of electrolytes, proteins, and other cellular compounds may be disrupted, leading to potential alterations in cell functions within the body; this is why several authors have linked this imbalance to a negative prognosis ( 39 ) .…”

Future lines of research on phase angle: Strengths and limitations

“…Low levels of PhA may indicate a worse prognosis and allow more appropriate supportive care for these patients. What we have learned in this infectious pathology opens the door for future studies in emerging pathologies for which we do not have reliable prognostic data [22,43].…”