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Bioelectrical impedance analysis predicts outcome in patients with suspected bacteremia

  • Clinical and Epidemiological Studies
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Summary

Fluid shifts from intracellular to extracellular water (ICW to ECW) are a feature of sepsis, caused by increased vascular permeability and cell catabolism. Changes in ECW and total body water (TBW) were assessed in a prospective observational study of patients with bacteremia by a bedside technique, and its prognostic impact determined. In 78 hospital patients with fever, the resistance ratio (Rinf/RO) and estimated ECW/TBW ratio from multifrequency bioelectrical impedance analysis, and serum albumin concentration were measured. Rinf/RO and ECW/TBW ratios decreased from day 0 to 2 in patients with significant bacteremia (n=31), but not in patients with doubtful or negative blood cultures (n=22 and 25). Increased Rinf/RO at baseline, and further increase of ECW/TBW from day 0 to 2, were associated with lower rate of recovery after 1 week and with higher mortality. Baseline Rinf/RO above the media (0.75) had positive and negative predictive values of 0.31 and 0.95 for death. This prognostic effect was independent of underlying disease and blood culture result in a multivariate model. Hypoalbuminemia at baseline was predictive of outcome, but changes in albumin from day 0 to 2 were unrelated to blood culture results or outcome. In patients with bacteremia, fluid shifts from intracellular to extracellular water occur early, are rapidly reversible by antibiotic treatment but are associated with adverse prognosis. Bioelectrical impedance deserves further study as a tool for bedside monitoring of patients with bacteremia.

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Authors and Affiliations

  1. Klinik I für Innere Medizin, Universität zu Köln, Josef-Stelzmann-Str. 9, D-50924, Köln, Germany

    A. Schwenk

  2. Dept. for Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

    A. Schwenk

  3. Dept. of Biochemistry, University of Queensland, St. Lucia, 4072, Brisbane, Queensland, Australia

    L. C. Ward Ph. D.

  4. MRC Dunn Clinical Nutrition Centre, CB2 2DH, Cambridge, UK

    L. C. Ward Ph. D. & M. Elia M. D., Ph. D.

  5. Dept. for Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., WC1E 7HAT, London, UK

    G. M. Scott M. D.

  6. Dept. of Clinical Microbiology, University College London Hospitals, Grafton Way, WC1E 6DB, London, UK

    G. M. Scott M. D.

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  1. A. Schwenk
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  2. L. C. Ward Ph. D.
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  3. M. Elia M. D., Ph. D.
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  4. G. M. Scott M. D.
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Schwenk, A., Ward, L.C., Elia, M. et al. Bioelectrical impedance analysis predicts outcome in patients with suspected bacteremia. Infection 26, 277–282 (1998). https://doi.org/10.1007/BF02962247

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  • DOI: https://doi.org/10.1007/BF02962247

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