Phase Angle and Handgrip Strength as a Predictor of Disease-Related Malnutrition in Admitted Patients: 12-Month Mortality

Abstract

Background: Phase Angle (PhA) value measured by bioelectrical impedance analysis (BIA) could be considered a good marker of the patient’s cell mass and cellular damage. Various studies have shown that the value of PhA is associated with an increased nutritional risk in several pathologies. However, not many studies have focused on the use of PhA as a screening tool in admitted patients. The aim of this study is to evaluate the prognostic value of PhA to determine disease-related malnutrition (DRM) and the risk that this entails for mortality and length of stay (LOS). Methods: 570 patients admitted to the hospital for different causes were included in this retrospective observational study. Patients’ nutritional risk was assessed by screening tests such as the Malnutrition Universal Screening tool (MUST) and Subjective Global Assessment (SGA), in addition to non-invasive functional techniques, such as BIA and handgrip strength (HGS), 24–48 h after admission. After performing an SGA as the gold standard to assess malnutrition, PhA and SPhA values were used to determine DRM. Furthermore, both samples: malnutrition status (MS) and non-malnutrition status (NMS) were compared, with SphA-Malnutrition corresponding to a diagnosis of malnutrition. Statistical analysis of the sample was conducted with JAMOVI version 2.2.2. Results: Patients with MS had lower PhA and SPhA than patients with NMS (p < 0.001). The ROC curve analysis (AUC = 0.81) showed a cut-off point for MS for PhA = 5.4° (sensitivity 77.51% and specificity 74.07%) and AUC = 0.776 with a cut-off point for SPhA = −0.3 (sensitivity 81.74% and specificity 63.53%). Handgrip strength (HGS) was also observed to be a good predictor in hospitalized patients. Carrying out a comparative analysis between MS and NMS, length of stay (LOS) was 9.0 days in MS vs. 5.0 days in NMS patients (OR 1.07 (1.04–1.09, p < 0.001)). A low SPhA-malnutrition value (SPhA < −0.3) was significantly associated with a higher mortality hazards ratio (HR 7.87, 95% CI 2.56–24.24, p < 0.001). Conclusion: PhA, SPhA and HGS are shown to be good prognostic markers of DRM, LOS and mortality and could therefore be useful screening tools to complement the nutritional assessment of admitted patients.

Phase Angle as a Potential Screening Tool in Adults with Metabolic Diseases in Clinical Practice: A Systematic Review

“…In hospitalized patients, PhA could be used as an additional resource to identify subjects at risk of malnutrition and functionality level. Fernandez-Jiménez et al [ 11 ] established that PhA values of ≤5.4° and ≤5.3° in men and women, respectively, admitted to hospital for different causes, were significantly associated with malnutrition or malnutrition-related diseases, as sorted by the malnutrition universal screening tool (MUST) scale.…”

“…According to our findings, PhA could be useful to identify subjects at risk of malnutrition in patients admitted to hospital for different causes (≤5.4° and ≤5.3° in men and women, respectively) [ 11 ], and functionality impairment in patients with acute stroke (men < 5.62° and women < 4.54°) [ 12 ]. These findings suggest that in the hospitalization context, a consideration of PhA to identify subjects with malnutrition and promptly initiate a suitable nutritional therapy should be incorporated to prevent length of stay and associated complications of malnutrition [ 26 ].…”

Phase Angle and Handgrip Strength as Predictors of Clinical Outcomes in Hospitalized COVID-19 Patients

“…On the other hand, the study from Jansen et al [ 29 ] in critically ill patients showed that a decreased standardized PhA (sPhA) increased the possibility for a patient to be diagnosed with malnutrition. Previous studies have also evaluated other nutritional markers, such as HGS as predictors of malnutrition [ 55 ].…”

“…Xu et al demonstrated that the prevalence of sarcopenia was 48% based on evidence from 5407 COVID-19 patients. Sarcopenia in COVID-19 patients has been recently reported to be associated with increased complications and mortality [ 55 ]. As HGS is a marker of sarcopenia [ 24 ], it is suggested to be used as a prognostic marker of COVID-19 patients [ 54 ] and patients with low HGS on admission should be closely monitored as patients at greater risk of adverse outcomes.…”

Protocol for a prospective cohort study on the feasibility of application of nutritional ultrasound in the diagnosis and follow-up of patients with nutritional risk at hospital discharge: Study on body composition and function (DRECO)

“…A recent study conducted by Fernandez-Jimenez, et al found that a low SPhA (standardised phase angle)-malnutrition value (SPhA < −0.3) was significantly associated with a higher mortality hazards ratio (HR 7.87, 95% CI 2.56-24.24, p < 0.001). This biological marker could therefore be incorporated among the screening tools and mortality risk assessment in this population (11).…”