The impact of the preoperative value of phase angle in bioelectrical impedance analysis on postoperative complications after pancreaticoduodenectomy.

Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), is an indicator of cell membrane health. Low PhA values reflect poor cellular function and low muscle mass. However, consensus regarding the appropriate cutoff value of PhA remains insufficient, and its impact on outcomes after esophagectomy in patients with esophageal malignancies is not well studied. We aimed to investigate whether preoperative PhA is associated with postoperative complication risk and survival prognosis and whether PhA decrease during the surgical preparation period is a prognostic factor in patients with esophageal cancer. This retrospective cohort study analyzed data from 194 patients who had undergone esophagectomy for esophageal malignancies. A PhA measured several days before surgery, with cutoff values of 5.0° for men and 4.2° for women, was used. The relationship between postoperative pneumonia and clinicopathological factors and between low PhA and postoperative outcomes and survival prognosis was investigated. The preoperative PhA decline and survival prognosis were analyzed in 134 patients whose PhA was measured twice before surgery. Overall, 93 and 101 patients were classified into the low and high PhA groups, respectively. A multivariate analysis showed that a serum albumin level lower than 3.5 g/dL and low PhA were independent risk factors for pneumonia (odds ratio [OR] = 3.40, P = 0.03; OR = 3.42, P = 0.03, respectively). The low PhA group exhibited significantly higher intraoperative fluid balance (6.7 versus 6.0 mL/kg/h, P = 0.01) and a higher proportion of patients who failed to achieve early mobilization on the first postoperative day (46 versus 32%, P = 0.04) than did the high PhA group. Multivariate analysis using a Cox proportional hazards model revealed that low PhA was a poor survival prognostic factor, independent of the clinical stage of esophageal cancer (hazard ratio = 2.61, P < 0.01). In patients whose PhA was measured twice preoperatively, a decrease in PhA during the preoperative period was a significant indicator of poor survival (hazard ratio = 2.59, P < 0.01). The group with a decrease in PhA during the preoperative period had significantly fewer steps than the group with an increase in PhA (6220 ± 2880 versus 8200 ± 2850, P < 0.01). Low PhA was a risk factor for postoperative pneumonia in patients who had undergone esophagectomy and was associated with poor survival prognosis. A decrease in PhA during the preoperative period was a significant poor prognostic factor. Increasing physical activity before surgery may lead to an increase in PhA. Thus, it is important to measure and evaluate PhA changes sequentially in patients with esophageal cancer.

POS0504 IS BIOELECTRICAL PHASE ANGLE ASSOCIATED WITH FUNCTIONAL STATUS AND DISEASE IMPACT IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients

In patients with gastrointestinal cancer with planned elective surgery, malnutrition increases the risk of adverse outcomes in the postoperative period. The phase angle, measured by the bioelectrical impedance analysis is an indicator of the metabolic and functional status of the patient. It may be an important prognostic indicator for the clinical outcome of post-surgical treatment in patients with gastrointestinal cancer. In this prospective study, 70 patients with gastrointestinal cancer had their phase angles measured by the bioelectrical impedance analysis before the surgery. During the first month after the surgery, we documented the postoperative complications from the patient's records and classified them according to the Clavien Dindo classification of surgical complications. The time of hospitalization was also recorded. The data was statistically analysed in SPSS. We found a statistically significant difference (p = 0.036) in the average value of phase angles between the group of patients who had postoperative complications (phase angle 5.09°) and the group without postoperative complications (5.64°). We noted a correlating trend of decreasing phase angle values and increasing hospitalization time (Pe R = -0,40, p = 0,001). The phase angle cut-off value (5.5°) was calculated using the ROC curve method, predicting a higher risk of the postoperative complications (p = 0,037) in patients with lower phase angle. Lower phase angle values before surgery were associated with more complications during the first month after surgery and longer hospitalization time. We found that a phase angle below than 5.5° could serve as a marker that predicts a greater risk of postoperative complications.

IntroductionThe phase angle (PhA), derived from bioelectrical impedance analysis (BIA), serves as an indicator of cellular health and body composition. While associated with muscle strength and exercise capacity in various conditions, its clinical relevance in chronic obstructive pulmonary disease (COPD) requires further characterization. This study aimed to evaluate the relationship between PhA, muscle strength, and physical function among individuals with COPD.MethodsBetween June 2024 and August 2025, 112 male patients with COPD and 20 healthy male controls were enrolled in this cross-sectional study. Assessments included pulmonary function, body composition via BIA, handgrip strength, knee extension strength, walking speed, and other clinical indicators. Relationships were analyzed using multivariable linear and least absolute shrinkage and selection operator (LASSO) regression models.ResultsPhA values were significantly lower in COPD patients than in healthy controls. Stratification of COPD patients by PhA revealed that a lower PhA was associated with progressively worse muscle strength, exercise capacity, and other clinical markers. Multivariable linear regression analyses demonstrated that a lower PhA was independently associated with slower walking speed (β = 0.061, p < 0.001) and reduced knee extension strength (β = 1.15, p = 0.002). Furthermore, PhA was selected as a key predictor in a prognostic model for severe physical impairment derived from the LASSO regression analysis.ConclusionIn this cross-sectional study, a lower PhA is independently associated with muscle weakness and impaired physical performance in men with COPD. These findings suggest that PhA may serve as a useful biomarker for assessing nutritional and functional status in this population. However, the cross-sectional design precludes causal inference, and the diagnostic utility of PhA for COPD itself is not established.

Phase Angle and Frailty Are Important Prognostic Factors in Critically Ill Medical Patients: A Prospective Cohort Study.

Introduction: Although the Clavien-Dindo classification (CDC) is the most widely utilized method for quantifying surgical complications, it fails to properly capture all events. To address this, the comprehensive complication index (CCI) was introduced. The purpose of this study was to compare the CCI and CDC as predictors of postoperative length of stay (PLOS) and total hospitalization costs in patients undergoing pancreaticoduodenectomy (PD). Methods: Data were collected from February 2018 to February 2021. Complications were graded on the CDC scale and the CCI was calculated for each patient. The correlations between CDC and CCI with PLOS and hospitalization costs were compared. Linear analyses were performed to identify factors associated with PLOS and costs. Results: 291 patients were enrolled with an average age of 61.2 years. 286 of them developed postoperative complications at CDC grade 1 (17.8%), 2 (59.9%), 3a (13.4%), 3b (4.5%), 4 (2.1%), and 5 (0.6%). Median CCI of the study cohort was 30.8. Spearman’s correlation analysis showed the CDC and CCI were significantly correlated with PLOS and hospitalization costs, but the CCI showed a stronger correlation with PLOS (+0.552 day of stay for each additional CCI point; CCI: ρ = 0.663 vs. CDC: ρ = 0.581; p = 0.036). There were no significant differences in the correlations between total hospitalization costs and the CDC or CCI (CCI: ρ = 0.566 vs. CDC: ρ = 0.565; p = 0.78). Conclusion: CCI is an accurate tool for quantifying morbidities after PD and shows a stronger correlation with PLOS compared with the CDC.

Background and Aims The energy protein wasting syndrome (EPWS) encompasses a range of pathologies associated with increased morbidity and mortality, directly related to patients undergoing hemodialysis (HD). The determination of phase angle (PA) has been associated in the literature in a directly proportional manner to the inflammatory/nutritional status of patients. Frailty, malnutrition, and sarcopenia feed back into these patients due to the high protein catabolism induced in part by the technique itself, dietary restrictions, and the aging of our patients, making the detection and treatment of this pathology a necessity that could positively impact the evolution and survival of patients. To describe the nutritional clinical status of patients in the Chronic Hemodialysis unit of a tertiary hospital. To determine the relationship of PA with nutritional status and morbidity/mortality. Method A unicentric cross-sectional study with a 12-month follow-up of patients in the chronic hemodialysis program at our hospital, with a multidisciplinary assessment (Nephrology and Nutrition). Nutritional status (NS) was determined by bioelectrical impedance analysis (BIA), obtaining PA and extracellular water ratio (ECWr) as markers of inflammation and hydration, biochemical parameters, and global subjective assessment (GSA) to identify the prevalence of EPWS in our unit. Results years, 41.7% female, and 53.4% diabetic. The mean BMI was 25.95 kg/m². The mean PA was 4°. The mean plasma albumin was 3.78 mg/dl. 39% of patients were diagnosed with moderate-severe malnutrition according to GSA. The mean ECWr was 0.401, which is associated with a state of overhydration. During the study, 18 patients (17.5%) died, with a mean PA of 3.9°. The mean plasma albumin was 3.6 mg/dl, and 38% of these patients presented clinical/analytical EPWS. Additionally, 10 patients (9.7%) underwent transplantation, with a mean PA of 5.49°. The mean plasma albumin was 4.06 mg/dl. Of the active patients in our unit (73), 27% met EPWS criteria based on the KDOQI guidelines of 2020. PA lower than 4 (P &amp;lt; 0.05) and malnutrition: Patients with a PA lower than 4 have a higher likelihood of having a higher degree of malnutrition (P = 0.034). PA lower than 4 and mortality: No significant relationship was found between a PA lower than 4 and mortality (P = 0.42), suggests that, within the context of the study, PA does not have a direct impact on mortality. Correlation between PA and mortality: The correlation coefficient of 0.21 indicates a weak positive relationship between PA and mortality, meaning that while there is a slight tendency for lower PA to be associated with higher mortality, the relationship is neither strong nor statistically significant. Degree of malnutrition and risk of mortality: The degree of malnutrition (P &amp;lt; 0.05) is associated with a higher risk of mortality (P = 0.006), and this finding is statistically significant. This suggests that more malnourished patients have a significantly higher risk of dying. Conclusion The prevalence of malnutrition in our hemodialysis unit is high and aligns with the range described in the literature. PA is proposed as a predictive variable for prognosis and mortality in these patients, similar to EPWS, showing a high percentage among deceased patients. We believe that advanced nutritional assessment should be part of the initial care for patients in hemodialysis. In conclusion, although low PA is associated with a higher degree of malnutrition, it does not have a direct significant impact on mortality. On the other hand, the degree of malnutrition is strongly related to a higher risk of mortality. However, studies with a larger number of patients are needed in order to continue demonstrating the relationship between these two variables.

The phase angle measured with bioelectrical impedance analysis (BIA) is one of the clinically important impedance parameters, and it is a predictor of prognosis and mortality for several diseases. The present cross-sectional study aimed to elucidate the association between osteoporosis and variables measured with BIA, including the phase angle. The study included 307 participants from an annual health checkup. All participants underwent measurement of bone status by quantitative ultrasound and body composition by BIA. Osteoporosis was diagnosed according to the WHO classification, and statistical comparisons were conducted between normal individuals and osteoporosis patients. Age, proteins, minerals, and the phase angle were significantly different between normal individuals and osteoporosis patients (p < 0.001). Furthermore, after controlling for age and sex, proteins, minerals, and the phase angle were significantly lower in osteoporosis patients than those in normal individuals (p < 0.001). In multivariate logistic regression analysis, older age and a low phase angle were risk factors for osteoporosis. Additionally, multiple regression analysis showed that age, sex, proteins, minerals, and the appendicular skeletal muscle index were significantly related to the phase angle. The phase angle is a predictor of osteoporosis, which is unaffected by age and sex, and a lower phase angle is associated with greater probability of osteoporosis. The phase angle can be easily measured, and osteoporosis can be confirmed even at home. This may facilitate early diagnosis and treatment, which may be useful for preventing diseases related to osteoporosis.

The comprehensive complication index (CCI) integrates all complications of the Clavien-Dindo classification (CDC) and offers a metric approach to measure morbidity. The aim of this study was to evaluate the CCI at a high-volume center for gastric cancer surgery and to compare the CCI to the conventional CDC. Clinical factors were collected from the prospective complication data of gastric cancer patients who underwent radical gastrectomy at Seoul National University Hospital from 2013 to 2014. CDC and CCI were calculated, and risk factors were investigated. Correlations and generalized linear models of hospital stay were compared between the CCI and CDC. The complication monitoring model with cumulative sum control-CCI (CUSUM-CCI) was displayed for individual surgeons, for comparisons between surgeons, and for the institution. From 1660 patients, 583 complications in 424 patients (25.5%) were identified. The rate of CDC grade IIIa or greater was 9.7%, and the overall CCI was 5.8±11.7. Age, gender, Charlson score, combined resection, open method, and total gastrectomy were associated with increased CCI (p<0.05). The CCI demonstrated a stronger relationship with hospital stay (ρ=0.721, p<0.001) than did the CDC (ρ=0.634, p<0.001). For prolonged hospital stays (≥30days), only the CCI showed a moderate correlation (ρ=0.544, p=0.024), although the CDC did not. The CUSUM-CCI model displayed dynamic time-event differences in individual and comparison monitoring models. In the institution monitoring model, a gradual decrease in the CCI was observed. The CCI is more strongly correlated with postoperative hospital stay than is the conventional CDC. The CUSUM-CCI model can be used for the continuous monitoring of surgical quality.

The Phase Angle and Mass Body Cell as Markers of Nutritional Status in Hemodialysis Patients

IntroTotal knee arthroplasty (TKA) and total hip arthroplasty (THA) are common procedures that improve mobility but carry a risk of postoperative complications, particularly in patients with obesity. Body Mass Index (BMI) is traditionally used for risk assessment but does not account for muscle mass or fat distribution. Bioelectrical impedance analysis (BIA) provides a more detailed body composition evaluation. This study investigates the association between BIA-derived metrics and postoperative complications in TKA and THA, hypothesizing that these metrics are superior predictors compared to BMI.MethodsA retrospective cohort study was performed on 567 adult patients who underwent primary THA or TKA from January 2020 to December 2023. The data collected included demographic characteristics, comorbidities, preoperative laboratory values, preoperative BIA measurements and postoperative complications. Multivariate logistic regression models were developed to identify independent predictors of postoperative complications. Receiver operating characteristic (ROC) curves assessed the predictive accuracy of BIA-metrics models compared to BMI model.ResultsIn a cohort of 567 patients (55.7% female, median age 66), no significant difference in BMI was found between the complication and non-complication groups. However, the complication group had a higher ECW/TBW ratio (0.396 vs. 0.393, p = 0.011), higher ECW/ICW ratio (0.657 vs. 0.647, p = 0.012), and a lower phase angle (4.65 vs. 4.80, p = 0.039). Multivariate logistic regression analysis revealed that higher standardized ECW/TBW (OR 1.65, 95% CI 1.17–2.31, p = 0.004) and ECW/ICW z-scores (OR 1.61, 95% CI 1.15–2.23, p = 0.005) were associated with increased odds of postoperative complications, while a lower phase angle was protective (OR 0.58, 95% CI 0.37–0.91, p = 0.018). ROC analysis showed moderate predictive accuracy for ECW/TBW (AUC 0.71, 95% CI 0.62–0.79), ECW/ICW (AUC 0.70, 95% CI 0.62–0.79), and phase angle (AUC 0.69, 95% CI 0.60–0.79). In contrast, BMI was not significantly associated with complications, and BMI model demonstrated inferior predictive accuracy (AUC 0.61)ConclusionECW/TBW, ECW/ICW and phase angle are associated with postoperative complications in patients undergoing primary TKA or THA. These metrics provide better predictive accuracy than BMI enhancing preoperative risk stratification.

Phase angle predicts survival in hemodialysis patients

The purpose of this study was to examine the predictive value of phase angle (PhA) in chronic spinal cord injury (SCI). This study includes 104 participants (52 for each group) of SCI patients and healthy subjects (HS) treated at the Indian Spinal Injury Centre (ISIC, New Delhi, India) between October 2020 and March 2021 A cross-sectional study was operated Bioelectrical Impedance Analysis (BIA) at 50 kHz and measured the prognostic effect of PhA on participants. An independent-sample t-test was used to estimate PhA between groups. Receiver Operating Characteristic (ROC) curves predicted the PhA cutoff and Youden&amp;rsquo;s index. There was a significant difference in PhA of gender, with p &amp;lt; 0.0001, a difference (2.40), 95% confidence interval (CI) (2.10 to 2.80), median (4.70) for the SCI group, and (7.1) for HS, respectively. In contrast, PhA was significantly different in males with p &amp;lt; 0.0001, a difference (2.60), 95% CI (3.00 to 2.10), median (5.0) for SCI, and (7.30) for HS, respectively. Similarly, PhA was significantly different in females, with p &amp;lt; 0.0001, a difference (1.9881), 95 % CI of difference (1.3565 to 2.6197), median (6.60) for SCI, and (4.40) for HS, respectively, as well as PhA cutoff values for SCI (female &amp;le; 4.4&amp;deg;; male &amp;le; 4.7&amp;deg;). The outcomes indicate a difference between groups of people with SCI and HS across the groups of gender, with a lower PhA in people with SCI.

Objective: The aim of the study was to evaluate different methods of nutritional status analysis like basic anthropometric data, laboratory data and bioelectrical impedance analysis (BIA) with phase angle (PA) in patients with chronic diseases. Setting: Clinic for Internal Medicine, Department of Nephrology, University Clinical Centre Maribor, a tertiary referral centre in Slovenia, Europe. Subjects: Patients with chronic disease and increased nutritional risk (≥1 fulfilled NRS 2002 criterion) at the time of inclusion in the study. Results: Patients had chronic kidney disease (93%), arterial hypertension (80%), active infection (33.3%), heart failure (23.3%), diabetes mellitus (20%), active malignancy (10%), autoimmune disease (6.6%), history of stroke (6.6%), chronic obstructive pulmonary disease (3.3%) and/or liver cirrhosis (3.3%). Mean serum albumin was 33.6±5.7 g/L, mean BMI 25.6±4.4 kg/m2 and mean PA 4.4±1.2º. No correlation between serum albumin and BMI was found. Lower PA was associated with lower serum albumin (p=0.045) and advanced age (p=0.043). The department nurses conducted nutritional education for all patients included in the study. Study was performed in accordance with the Strengthening the reporting of observational studies in epidemiology. Conclusion: Results of the study show the importance of nutritional risk assessment in all chronically ill patients. BIA is a promising method of determining nutritional status. PA values have important diagnostic, therapeutic and prognostic implications as they are a marker of body cell mass, membrane function and metabolic health. A multifaceted approach to assess malnutrition in patients with chronic diseases is important, followed by a prompt nutritional intervention.