Phase Angle and Handgrip Strength as Complements to Body Composition Analysis for Refining Prognostic Accuracy in Cardiac Surgical Patients

Abstract

This study aimed to benchmark the prognostic validity of nutritional status, body composition, phase angle, and muscle strength assessment on the basis of morbidity and mortality in the cardiac surgery population. Prospective, cohort study. Tertiary university hospital. Patients undergoing cardiac surgery procedures. Demographic, anthropometric, and clinical data registration, handgrip strength (HGS) measurement, and body composition assessment were performed the day before the scheduled surgery in a cohort of 179 cardiac surgery patients. Body composition parameters and HGS were reassessed on postoperative day seven (POD7). The study endpoints were the hospital length of stay (LOS) and in-hospital mortality. Data from a cohort of 179 patients were analyzed. Significant impairment of nutritional status, body composition parameters, and HGS were recorded on POD seven (p < 0.001), which was associated with prolonged hospital LOS (p < 0.05). Postoperative low phase angle (PhA) (odds ratio [OR] 4.366; 95% confidence interval [CI] 1.859-10.255; p = 0.001), reduced fat-free mass index (OR 1.077; 95% CI 1.020-1.137; p = 0.008), and expanded extracellular water (ECW) (OR 1.230; 95% CI 1.080-1.401; p = 0.002) were the most powerful predictors of prolonged hospital LOS, with PhA (hazard ratio [HR] 1.228; 95% CI 1.074-1.403; p = 0.003) and ECW (HR 0.945; 95% CI 0.909-0.982; p = 0.004) serving as predictors of in-hospital mortality. Postoperative PhA, ECW, and total body water presented superior or at least equivalent discrimination of morbidity or mortality to EuroSCORE II. Cardiac surgery patients are at risk of nutritional status deterioration during their hospitalization course, which, in turn, exerts an adverse effect on the outcome. Attenuation of PhA, deterioration of fat-free mass index, and edema development constitute potential surrogates to the prediction of morbidity and mortality.