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Body composition, energy expenditure and physical activity

Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study

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Abstract

Background

Bioelectrical impedance analysis (BIA) is a validated method to assess body composition in persons with fluid homeostasis and reliable body weight. This is not the case during critical illness. The raw BIA markers resistance, reactance, phase angle, and vector length are body weight independent. Phase angle reflects cellular health and has prognostic significance. We aimed to assess the course of phase angle and vector length during intensive care unit (ICU) admission, and determine the relation between their changes (Δ) and changes in body hydration.

Methods

A prospective, dual-center observational study of adult ICU patients was conducted. Univariate and multivariable regression analyses were performed, including reactance as a marker of cellular mass and integrity and total body water according to the Biasioli equation (TBWBiasioli) and fluid balance as body weight independent markers of hydration.

Results

One hundred and fifty-six ICU patients (mean ± SD age 62.5 ± 14.5 years, 67% male) were included. Between days 1 and 3, there was a significant decrease in reactance/m (−2.6 ± 6.0 Ω), phase angle (−0.4 ± 1.1°), and vector length (−12.2 ± 44.3 Ω/m). Markers of hydration significantly increased. Δphase angle and Δvector length were both positively related to Δreactance/m (r2 = 0.55, p < 0.01; r2 = 0.38, p < 0.01). Adding ΔTBWBiasioli as explaining factor strongly improved the association between Δphase angle and Δreactance/m (r2 = 0.73, p < 0.01), and Δvector length and Δreactance/m (r2 = 0.77, p < 0.01).

Conclusions

Our results show that during critical illness, changes in phase angle and vector length partially reflect changes in hydration.

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Fig. 1: Box plots of percentage change in R/m, Xc/m, phase angle, vector length, TBWBiasioli, TBWBodygram, hydration score, BCM, and MM between days 1 and 3.
Fig. 2: Correlations between changes in Xc/m, phase angle, vector length, CFB, TBWBiasioli, TBWBodygram, hydration score, MM, and BCM between days 1 and 3.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge the ICU research nurses for their invaluable help with the BIA measurements.

Funding

The present study was supported by departmental funding.

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Authors and Affiliations

  1. Department of Adult Intensive Care Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands

    Nadine Denneman, Bo Broens, Jolijn Gjaltema, Sandra N. Stapel, Julius Stohlmann & Heleen M. Oudemans-van Straaten

  2. Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Lara Hessels & Maarten W. Nijsten

Authors
  1. Nadine Denneman
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  2. Lara Hessels
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  3. Bo Broens
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  4. Jolijn Gjaltema
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  5. Sandra N. Stapel
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  8. Heleen M. Oudemans-van Straaten
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Contributions

ND is the main writer of the paper, collected the data for the Department of Adult Intensive Care Medicine, Amsterdam UMC, VU University Medical Center, analyzed, and interpreted the patient data. LH collected the data for the Department of Critical Care, University of Groningen, University Medical Centre Groningen, assisted with data analysis, and contributed to writing the paper. BB and JS contributed to collecting data for the Department of Adult Intensive Care Medicine, Amsterdam UMC, VU University Medical Center and to writing the paper. JG, SNS, and MWN contributed to writing the paper. HMOS participated in the design, the statistical analysis, interpretation of the data, and in the drafting and writing of the paper. All authors read and approved the final paper.

Corresponding author

Correspondence to Nadine Denneman.

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Conflict of interest

The bioelectrical impedance device was financed by an unrestricted research grant from Nutricia Medical Care.

Ethical approval

The study protocol was approved by the local research ethics committee (VU University Medical Center, amendment to METc reference number 2013.318, UMC Groningen, METc 2016.691). Since all patient data were anonymized and BIA is noninvasive with a low patient burden the need for informed consent was waived.

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Denneman, N., Hessels, L., Broens, B. et al. Fluid balance and phase angle as assessed by bioelectrical impedance analysis in critically ill patients: a multicenter prospective cohort study. Eur J Clin Nutr 74, 1410–1419 (2020). https://doi.org/10.1038/s41430-020-0622-7

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