Phase Angle for Nutritional Risk Screening in Cardiac Critically Ill Patients

Authors

  • Danielle Mitchell Tenório Pronto Socorro Cardiológico Universitário de Pernambuco, Universidade de Pernambuco, Palmares Street, no number, Santo Amaro, Recife-PE, Brazil.
  • Isa Galvão Rodrigues Pronto Socorro Cardiológico Universitário de Pernambuco, Universidade de Pernambuco, Palmares Street, no number, Santo Amaro, Recife-PE, Brazil.
  • José Gildo de Moura Monteiro Júnior Pronto Socorro Cardiológico Universitário de Pernambuco, Universidade de Pernambuco, Palmares Street, no number, Santo Amaro, Recife-PE, Brazil.
  • Cláudia Porto Sabino Pinho UNIVERSIDADE DE PERNAMBUCO

DOI:

https://doi.org/10.14306/renhyd.27.1.1760

Keywords:

Evaluación nutricional, Factores de riesgo, impedancia bioeléctrica, Cuidado crítico, Unidades de cuidados intensivos, Mortalidad

Abstract

Introduction: The phase angle has been listed as a nutritional marker and its useful role in critically ill patients, but its role as a patient-to-patient tool has not yet been tested. This study sought to evaluate the phase angle as a proposal to determine nutritional risk in critically ill patients hospitalized in cardiac intensive care units.

Methods: Transversal study, coupled to a prospective analysis variable (hospitalization outcome) and involving adult and elderly male and female patients in cardiac intensive care units. The nutritional risk was determined by using the NUTRICscore, the phase angle was obtained through bioelectrical impedance analysis and other data, through the clinical record. A significance level of p <0.05 was used for all statistical analysis.

Results: 79 patients were included and resulted in homogeneous distribution among the sexes and an average age of 67.2 ± 13.7 years. Most of the sample had malnutrition according to the body mass index (BMI) (46.7%; CI: 36.0-57.8) and due to the adequacy of the arm circumference (40.8%; CI: 34.0-52.0). According to the NUTRIC score, 59.5% (CI: 48.5-69.3) had a high nutritional risk, and 68.4% (CI: 57.4-77.6) had a low phase angle (≤5.5 °). Correlation between the phase angle and age (p = 0.010) and BMI (p = 0.023) was verified. A good sensitivity (72%; CI: 55.6-81.9) and specificity (68%; CI: 42.5-77.5) of the low phase angle were obtained to detect nutritional risk by NUTRIC.

Conclusions: The PhA had good results of sensitivity and specificity but should be used with caution to determine the nutritional risk in critically ill cardiac patients.

References

(1) Santos JCO, Mendonça MAO. Factors predisposing for acute kidney injury in patients in critical condition: integrative review. Rev Soc Bras Clin Med; jan-mar. 2015; 13(1): 69-74.

(2) Gonzalez MC, Bielemann RM, Kruschardt PP, Orlandi SP. Complementarity of NUTRIC score and Subjective Global Assessment for predicting 28-day mortality in critically ill patients. Clin Nutr 2019;38(3):2846-50.

(3) Sant’ana IES, Mendonça SS, Marshall NG. Protein-calorie adequacy and determining factors that inhibit adequate enteral nutritional delivery in critically ill patients. Com. Ciências Saúde, 2013;22(4):47-56.

(4) Oshima T, Deutz NE, Doing G, Wischmeyer PE, Pichard C. et al. Protein-energy nutrition in the ICU is the power couple: A hypothesis forming analysis. Clin Nutr 2016;35(4): 968-74.

(5) Cabral CR, Teixeira C, Rosa RG, Robinson C, Sganzerla D, Loss SH, et al. Mortality, morbidity, and quality-of-life outcomes of patients requiring ≥ 14 days of mechanical ventilation: a 12-month post-intensive-care-unit cohort study. Rev Bras TerIntensiva; 2019,31(3):425-427.

(6) Mendes R, Policarpo S, Fortuna P, Alves M, Virella D, Heyland DK. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients—A multicenter prospective cohort study. J Cri Care 2017; 37:45–9.

(7) Becker T, Zanchim MC, Mognon A, Junior LRC, Cibulski TP, Correa JA. et al. Nutritional risk of critically ill patients using the NUTRIC Score. BRASPEN J 2018;33(1): 26-31.

(8) Reis AM, Fructhenicht AVG, Moreira LF. NUTRIC score use around the world: a systematic review. Rev Bras Ter Intensiva 2019;31(3):379-85.

(9) Koehler KB, Moraes RAG, Rodrigues JB, Portela BSM, Miguel GPS, Pedrosa RG. et al. Bioimpedance phase angle is associated with serum transthyretin but not with prognostic inflammatory and nutritional index during follow-up of women submitted to bariatric surgery. ClinNutri ESPEN, 2019; 33, 183-7.

(10) Uemura K, Doi T, Tsutsumimoto K, Nakakubo S, Kim M, Kurita S. et al. Predictivity of bioimpedance phase angle for incident disability in older adults.Journal of Cachexia, Sarcopenia and Muscle 2019;11(1):46-54.

(11) Thibault R, Makhlouf A-M, Mulliez AM, Gonzalez C, Kekstas G, et al. Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study phase angle project. Intensive Care Med; 2016; 42:1445–53.

(12) Silva RRL, Pinho CPS, Rodrigues IG, Monteiro Junior JGM. Phase angle as an indicator of nutritional status and prognosis in critically ill patients. Nutri Hosp 2004;12(31):1278-85.

(13) Panagidi M, et al. Prognostic value of combined preoperative phase angle and handgrip strength in cardiac surgery. J Cardiothoracic Surgery 2022;17(227):1-7.

(14) Razzera EL, Marcadenti A, Rovedder SW, Alves FD, FINK JS, SILVA FM, Parameters of Bioelectrical Impedance Are Good Predictors of Nutrition Risk, Length of Stay, and Mortality in Critically Ill Patients: A Prospective Cohort Study. J Parenter Enteral Nutr.2019;44(5):1-6.

(15) Santos HVD, Araújo IS. Impact of protein intake and nutritional status on the clinical outcome of critically ill patients. Rev Bras Ter Intensiva. 2019; 31(2):210-6.

(16) Silva RRL, Pinho CPS, Rodrigues IG, Junior JGMM. Phase angle as an indicator of nutritional status and prognosis in critically ill patients. Nutr Hospital, 2014;31. 1278-85.

(17) Alves FD, Souza GC, Clausell N, Biolo A. Prognostic role of phase angle in hospitalized patients with acute decompensated heart failure. Clin Nutr 2016;35(6): 1530-4.

(18) Ringaitiene D, Gineityte D, Vicka V, Zvirblis T, Norkiene I, Sipylaite J, et al. Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients. ClinNutr; 2016, 35: 1328-32.

(19) Paes TCA, Oliveira KCC, Padilha PC, Peres WAF. Phase angle assessment in critically ill cancer patients: relationship with the nutritional status, prognostic factors and death. J Cri Care; 2018; 44(6):430-5.

(20) Al-Kalaldeh M. Suleiman K, Al-Kalaldeh O. Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence with the Bioelectrical Impedance Analysis. Nutr Clin Pract.2019, 1-8.

(21) Rinaldi S, Gilliland J, O’connor C, Chesworth B, Madill J. Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review. ClinNutr ESPEN. 2019, 1- 14.

(22) Cioffi I, Marra M, Imperatore N, Pagano MC, Santarpia L, Alfonsi L, Testa A, Sammarco R, Contaldo F, Castiglione F, et al. Assessment of bioelectrical phase angle as a predictor of nutritional status in patients with Crohn’s disease: A cross sectional study. ClinNutr 2020;39(5):1564-71.

(23) Bonfada D, Santos MM, Lima, KC, Garcia-Altés A. Survival analysis of elderly patients in Intensive Care Units. Rev Bras Geriatr Gerontol. Rio de Janeiro; 2017 20(2): 198-206.

(24) José IB, Leandro-Merhi VA, Aquino JLB, Mendonça JA. The diagnosis and NUTRIC score of critically ill patients in enteral nutrition are risk factors for the survival time in an intensive care unit? Nutr Hospital; 2019; 36(5):1027-1036.

(25) Aguiar-Ricardo I, Mateus H, Gonçalves-Pereira J. Hidden hospital mortality in patients with sepsis discharged from the intensive care unit. Rev Bras Ter Intensiva. 2019; 31(2):122-8.

(26) Costa, R. A. Mortality of patients admitted by sepse in a general ICU of a tertiary hospital. Arq Catarin Med. Out-dez 2018; 47(4):15-28.

(27) Bector S, Vagianos K, Suh M, Duerksen Dr. Does the Subjective Global Assessment Predict Outcome in Critically Ill Medical Patients? J Intensive Care Med, 2016, 31(7) 485-9.

(28) Ozbilgin S, Hanci V, OmurD,Ozbilgin M, Tosun M, Yurtlu S, Kucukguclu S, Arkan A. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine, 2016; 95, 5038.

(29) Stapel SN, Looijaard WGPM, Dekker IM, Girbes ARJ, Weijs PJM, Oudemans-van Straaten HM. Bioelectrical impedance analysis-derived phase angle at admission as a predictor of 90-day mortality in intensive care patients. Euro J ClinNutr; 2018;1-7.

(30) Genton L, Herrmann FR, Sporri, Graf CE. Association of mortality and phase angle measured by different bioelectrical impedance analysis (BIA) devices. ClinNutr. 2018;37(3):1060-9.

(31) Garlini LM, Alves FD, Ceretta LB, Perry IS, Souza GC, ClausellNO. Phase angle and mortality: a systematic review. Euro J Clin Nutr 2019;73(4):495-508.

(32) Tomeleri CM, et al. Phase angle is related with inflammatory and oxidative stress biomarkers in older women. Exp Gerontol 2018; 102:12-8

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Published

2023-02-01

How to Cite

Tenório, D. M., Rodrigues, I. G., Júnior, J. G. de M. M., & Pinho, C. P. S. (2023). Phase Angle for Nutritional Risk Screening in Cardiac Critically Ill Patients. Spanish Journal of Human Nutrition and Dietetics, 27(1), 43–50. https://doi.org/10.14306/renhyd.27.1.1760

Issue

Vol. 27 No. 1 (2023): Spanish Journal of Human Nutrition and Dietetics

Section

Research articles

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Copyright (c) 2020 Danielle Mitchell Tenório, Isa Galvão Rodrigues, José Gildo de Moura Monteiro Júnior, Cláudia Porto Sabino Pinho

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