Whole-body and segmental bioelectrical parameters in chronic liver disease: Effect of gender and disease stages

Abstract

The aim of this study was to examine and compare whole-body and segmental impedance measurements in control subjects and patients with progression of liver disease and to investigate whole-body and segmental bioelectrical changes occurring during dehydration therapy or paracentesis. Males have lower resistance (R) and reactance (Xc) values than females in measurements both of the whole body and of the arm, leg, and trunk. This is not true in patients. In the three groups of patients, whole-body R and Xc were lower in each increased disease stage, suggesting that stage has a significant main effect on impedance measurements. The lower extremities were the segment most influenced by the progression of liver disease. The sum of the arm and leg R was only slightly lower than the value of whole-body resistance. The trunk has a meager influence on this parameter, as is clearly shown by the absence of variations before and immediately after paracentesis. In edematous cirrhotic patients without ascites treated with diuretics, our data also showed a significant correlation (r = .81; SEE = 1.2) between changes in body weight (BW) and in the bioelectrical evaluation of total body water (TBW). The association of a prevalent increment of Xc (approximately 40%) with a reduction of extracellular water is the most significant bioelectrical event during dehydration therapy. All these findings show that impedance measurements have a low sensitivity in detecting the volume of ascites in cirrhotic patients, whereas Xc has a clinical use in monitoring changes in extracellular water (EW).

Value of the extracellular water ratio for assessment of cirrhotic patients with and without ascites

“…P ATIENTS WITH CIRRHOSIS often have an abnormal body composition with clinical signs of protein-energy malnutrition and a relative increase in body weight due to ascites or edema. [1][2][3] Ascites is a condition that is becoming treatable with diuretics, albumin preparations, ascetic reperfusion, and transjugular intrahepatic portosystemic shunting, but the prognosis of patients with ascites remains poor. 4,5 Heuman et al studied 507 cirrhotic patients referred for consideration of liver transplantation and concluded that the presence of persistent ascites is an important independent predictor of high mortality risk.…”

Current Techniques of Fluid Status Assessment

“…BIVA thus measures whole-body fluid volume [47,48], has a correlation coefficient of 0.996, and a measurement error that ranges from 2 to 4%. BIVA provides data on volume status and has been validated in kidney [49], liver, and heart disease [50][51][52]. In one study using BIVA as a proxy for the adequacy of ultrafiltration in over 3,000 hemodialysis patients, BIVA indices reflecting greater soft tissue hydration (less adequate ultrafiltration) were associated with a significant increase in mortality [53].…”

Noninvasive Volume Assessment in the Emergency Department: A Look at B-Type Natriuretic Peptide and Bioimpedance Vector Analysis

“…BIVA has been used in the analysis of volume depletion [15] as well as several volumeoverloaded disease processes, e.g. heart failure [16], kidney failure [17], and liver disease [18]. It is superior in assessing for volume overload compared to anthropometric measurements, with a sensitivity of 88% and specificity of 87% for detecting edema by vector analysis on the RXc graph [19].…”