Intensive Care Medicine

, Volume 42, Issue 9, pp 1445–1453 | Cite as

Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project

  • Ronan ThibaultEmail author
  • Anne-Marie Makhlouf
  • Aurélien Mulliez
  • M. Cristina Gonzalez
  • Gintautas Kekstas
  • Nada Rotovnik Kozjek
  • Jean-Charles Preiser
  • Isabel Ceniceros Rozalen
  • Sylvain Dadet
  • Zeljko Krznaric
  • Kinga Kupczyk
  • Fabienne Tamion
  • Noël Cano
  • Claude Pichard
  • Phase Angle Project Investigators



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.


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.


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].


Low fat-free mass at ICU admission is associated with 28-day mortality. A combined score improves mortality predictability.

Trial registration: NCT01907347 (


Bioelectrical impedance analysis Severity of illness index Body composition Critical illness Critical care outcomes 



The authors gratefully thank Gaëlle Emvalomenos and Thora Theodorsdottir for their help in recruiting patients at Geneva University Hospital and database management and all of the nursing staff and physicians in all the investigating centres. We especially thank Dr. Fabrice Kwiatkowski, biostatistician, at Jean Perrin’s Cancer Centre, Clermont-Ferrand, France, for his careful review of all statistical analyses.

Phase Angle Project Investigators: Séverine Graf, Claudia P Heidegger (Geneva), Marcio Guerreiro, Silvana Orlandi (Pelotas), Andrius Klimasauskas, Gintare Sostakaite (Vilnius University), Kristina Gorjup, Katja Kogovšek, Katja Kopriva Pirtovšek (Ljubljana), Michelle Norrenberg, Karen Rizkallah, François Wéry (Brussels), Ali Ait Hssain, Bruno Pereira, Bertrand Souweine (Clermont-Ferrand), Steven Grange, Antoine Marchalot, Pauline Bernier-Enguerrand (Rouen), Marlena Jakubczyk, Aleksandra Różowicz, Stanisław Kłęk (Bydgoszcz, Skawina), Ana Kunovic (Zagreb).

Compliance with ethical standards


The Phase Angle Project was supported by the European Society for Clinical Nutrition and Metabolism (ESPEN) as a fellowship Grant 2012 allocated to Ronan Thibault. Additional research Grants (5 % of the main funding by ESPEN) were obtained from Bioparhom, Le Bourget-du-Lac, France and the public Foundation Nutrition 2000Plus, Switzerland.

Conflicts of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Ronan Thibault
    • 1
    • 2
    Email author
  • Anne-Marie Makhlouf
    • 1
  • Aurélien Mulliez
    • 3
  • M. Cristina Gonzalez
    • 4
  • Gintautas Kekstas
    • 5
  • Nada Rotovnik Kozjek
    • 6
  • Jean-Charles Preiser
    • 7
  • Isabel Ceniceros Rozalen
    • 8
  • Sylvain Dadet
    • 9
  • Zeljko Krznaric
    • 10
  • Kinga Kupczyk
    • 11
  • Fabienne Tamion
    • 12
  • Noël Cano
    • 13
  • Claude Pichard
    • 1
  • Phase Angle Project Investigators
  1. 1.Nutrition UnitGeneva University HospitalsGenevaSwitzerland
  2. 2.Nutrition Unit, Department of Endocrinology, Diabetology and Nutrition, INSERM U991CHU Rennes–Université Rennes 1RennesFrance
  3. 3.Department of Biostatistics, Direction of Clinical Research and Innovation (DRCI)CHU Clermont-FerrandClermont-FerrandFrance
  4. 4.Post-graduate Program in Health and BehaviorCatholic University of PelotasPelotasBrazil
  5. 5.Department of Intensive CareVilnius University HospitalVilniusLithuania
  6. 6.Clinical Nutrition UnitInstitute of OncologyLjubljanaSlovenia
  7. 7.Department of Intensive CareHôpital Universitaire ErasmeBrusselsBelgium
  8. 8.Department of Intensive CareClinic USP PalmaplanasPalma de MajorqueSpain
  9. 9.Department of NutritionCHU Clermont-FerrandClermont-FerrandFrance
  10. 10.Departement of Internal MedicineUniversity Hospital Center ZagrebZagrebCroatia
  11. 11.Department of Anesthesiology and Intensive Care, University Hospital No. 1, Collegium Medicum Nicolaus Copernicus UniversityBydgoszczPoland
  12. 12.Department of Intensive CareCHU RouenRouenFrance
  13. 13.Centre de Recherche en Nutrition Humaine d’Auvergne (CRNH)CHU Clermont-FerrandClermont-FerrandFrance

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