Ronan Thibault1,2, Anne-Marie Makhlouf3, Aurélien Mulliez4, M Cristina Gonzalez5, Gintautas Kekstas6, Nada Rotovnik Kozjek7, Jean-Charles Preiser8, Isabel Ceniceros Rozalen9, Sylvain Dadet10, Zeljko Krznaric11, Kinga Kupczyk12, Fabienne Tamion13, Noël Cano14, Claude Pichard3. 1. Nutrition Unit, Geneva University Hospitals, Geneva, Switzerland. ronan.thibault@chu-rennes.fr. 2. Nutrition Unit, Department of Endocrinology, Diabetology and Nutrition, INSERM U991, CHU Rennes-Université Rennes 1, 2, rue Henri Le Guilloux, 35000, Rennes, France. ronan.thibault@chu-rennes.fr. 3. Nutrition Unit, Geneva University Hospitals, Geneva, Switzerland. 4. Department of Biostatistics, Direction of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France. 5. Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil. 6. Department of Intensive Care, Vilnius University Hospital, Vilnius, Lithuania. 7. Clinical Nutrition Unit, Institute of Oncology, Ljubljana, Slovenia. 8. Department of Intensive Care, Hôpital Universitaire Erasme, Brussels, Belgium. 9. Department of Intensive Care, Clinic USP Palmaplanas, Palma de Majorque, Spain. 10. Department of Nutrition, CHU Clermont-Ferrand, Clermont-Ferrand, France. 11. Departement of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia. 12. Department of Anesthesiology and Intensive Care, University Hospital No. 1, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. 13. Department of Intensive Care, CHU Rouen, Rouen, France. 14. Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH), CHU Clermont-Ferrand, Clermont-Ferrand, France.
Abstract
PURPOSE: Phase angle as measured by bioelectrical impedance analysis reflects fat-free mass. Fat-free mass loss relates to worse prognosis in chronic diseases. Primary aim of this study was: to determine the association between fat-free mass at intensive care unit admission and 28-day mortality. METHODS: Ten centres in nine countries participated in this multicentre prospective observational study. The inclusion criteria were age >18 years; expected length of stay >48 h; absence of pacemaker, heart defibrillator implant, pregnancy and lactation. Fat-free mass was assessed by measurement of the 50-kHz phase angle at admission. The primary endpoint was 28-day mortality. The area under the receiver operating characteristic curve (AUC) was used to assess prediction of 28-day mortality by fat-free mass at ICU admission. The variables associated with 28-day mortality were analysed by means of multivariable logistic regression. RESULTS: Of the 3605 patients screened, 931 were analysed: age 61 ± 16 years, male 60 %, APACHE II 19 ± 9, body mass index 26 ± 6, day 1 phase angle 4.5° ± 1.9°. Day 1 phase angle was lower in patients who eventually died than in survivors (4.1° ± 2.0° vs. 4.6° ± 1.8°, P = 0.001). The day 1 phase angle AUC for 28-day mortality was 0.63 [0.58-0.67]. In multivariable analysis, the following were independently associated with 28-day mortality: age (adjusted odds ratio (aOR) 1.014 [95 % confidence interval 1.002-1.027], P = 0.03), day 1 phase angle (aOR 0.86 [0.78-0.96], P = 0.008), APACHE II (aOR 1.08 [1.06-1.11], P < 0.001), surgical patient (aOR 0.51 [0.33-0.79], P = 0.002), and admission for other diagnosis (aOR 0.39 [0.21-0.72], P = 0.003). A multivariable combined score improved the predictability of 28-day mortality: AUC = 0.79 [0.75-0.82]. CONCLUSION: Low fat-free mass at ICU admission is associated with 28-day mortality. A combined score improves mortality predictability. TRIAL REGISTRATION: NCT01907347 ( http://www.clinicaltrials.gov ).
PURPOSE: Phase angle as measured by bioelectrical impedance analysis reflects fat-free mass. Fat-free mass loss relates to worse prognosis in chronic diseases. Primary aim of this study was: to determine the association between fat-free mass at intensive care unit admission and 28-day mortality. METHODS: Ten centres in nine countries participated in this multicentre prospective observational study. The inclusion criteria were age >18 years; expected length of stay >48 h; absence of pacemaker, heart defibrillator implant, pregnancy and lactation. Fat-free mass was assessed by measurement of the 50-kHz phase angle at admission. The primary endpoint was 28-day mortality. The area under the receiver operating characteristic curve (AUC) was used to assess prediction of 28-day mortality by fat-free mass at ICU admission. The variables associated with 28-day mortality were analysed by means of multivariable logistic regression. RESULTS: Of the 3605 patients screened, 931 were analysed: age 61 ± 16 years, male 60 %, APACHE II 19 ± 9, body mass index 26 ± 6, day 1 phase angle 4.5° ± 1.9°. Day 1 phase angle was lower in patients who eventually died than in survivors (4.1° ± 2.0° vs. 4.6° ± 1.8°, P = 0.001). The day 1 phase angle AUC for 28-day mortality was 0.63 [0.58-0.67]. In multivariable analysis, the following were independently associated with 28-day mortality: age (adjusted odds ratio (aOR) 1.014 [95 % confidence interval 1.002-1.027], P = 0.03), day 1 phase angle (aOR 0.86 [0.78-0.96], P = 0.008), APACHE II (aOR 1.08 [1.06-1.11], P < 0.001), surgical patient (aOR 0.51 [0.33-0.79], P = 0.002), and admission for other diagnosis (aOR 0.39 [0.21-0.72], P = 0.003). A multivariable combined score improved the predictability of 28-day mortality: AUC = 0.79 [0.75-0.82]. CONCLUSION: Low fat-free mass at ICU admission is associated with 28-day mortality. A combined score improves mortality predictability. TRIAL REGISTRATION: NCT01907347 ( http://www.clinicaltrials.gov ).
Entities:
Keywords:
Bioelectrical impedance analysis; Body composition; Critical care outcomes; Critical illness; Severity of illness index
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