Abstract
Background/ObjectivesA low bioelectrical impedance analysis (BIA)-derived phase angle (PA) predicts morbidity and mortality in different patient groups. An association between PA and long-term mortality in ICU patients has not been demonstrated before. The purpose of the present study was to determine whether PA on ICU admission independently predicts 90-day mortality.Subjects/ methodsThis prospective observational study was performed in a mixed university ICU. BIA was performed in 196 patients within 24 h of ICU admission. To test the independent association between PA and 90-day mortality, logistic regression analysis was performed using the APACHE IV predicted mortality as confounder. The optimal cutoff value of PA for mortality prediction was determined by ROC curve analysis. Using this cutoff value, patients were categorized into low or normal PA group and the association with 90-day mortality was tested again.ResultsThe PA of survivors was higher than of the non-survivors (5.0° ± 1.3° vs. 4.1° ± 1.2°, p < 0.001). The area under the ROC curve of PA for 90-day mortality was 0.70 (CI 0.59–0.80). PA was associated with 90-day mortality (OR = 0.56, CI: 0.38–0.77, p = 0.001) on univariate logistic regression analysis and also after adjusting for BMI, gender, age, and APACHE IV on multivariable logistic regression (OR = 0.65, CI: 0.44–0.96, p = 0.031). A PA < 4.8° was an independent predictor of 90-day mortality (adjusted OR = 3.65, CI: 1.34–9.93, p = 0.011).ConclusionsPhase angle at ICU admission is an independent predictor of 90-day mortality. This biological marker can aid in long-term mortality risk assessment of critically ill patients.
Highlights
Identification of critically ill patients with a high risk of mortality is important to guide preventive and supportive measures
1350 patients were admitted to the intensive care unit (ICU) with a mean age of 62.6 ± 16.1 years and a mean Acute Physiology and Chronic Health Evaluation (APACHE) IV-predicted mortality score of 0.17 ± 0.21
Bioelectrical impedance analysis (BIA) was performed in 202 patients within 24 h of ICU admission
Summary
Identification of critically ill patients with a high risk of mortality is important to guide preventive and supportive measures. The present scoring systems are designed to predict hospital mortality but not mortality beyond hospital discharge and can only be assessed 24 h after intensive care unit (ICU) admission. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is an alternative method to assess mortality risk. Impedance consists of two components: resistance (R), which is the opposition to the flow of an alternating current through intra- and extracellular ionic solutions, and reactance (Xc), which is the delay in conduction as a result of capacitance by cell membranes and tissue interfaces. An association between PA and long-term mortality risk in ICU patients has not been demonstrated before
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