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

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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).

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Acknowledgments

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).

Author information

Authors and Affiliations

  1. Nutrition Unit, Geneva University Hospitals, Geneva, Switzerland

    Ronan Thibault, Anne-Marie Makhlouf & Claude Pichard

  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

  3. Department of Biostatistics, Direction of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France

    Aurélien Mulliez

  4. Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil

    M. Cristina Gonzalez

  5. Department of Intensive Care, Vilnius University Hospital, Vilnius, Lithuania

    Gintautas Kekstas

  6. Clinical Nutrition Unit, Institute of Oncology, Ljubljana, Slovenia

    Nada Rotovnik Kozjek

  7. Department of Intensive Care, Hôpital Universitaire Erasme, Brussels, Belgium

    Jean-Charles Preiser

  8. Department of Intensive Care, Clinic USP Palmaplanas, Palma de Majorque, Spain

    Isabel Ceniceros Rozalen

  9. Department of Nutrition, CHU Clermont-Ferrand, Clermont-Ferrand, France

    Sylvain Dadet

  10. Departement of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia

    Zeljko Krznaric

  11. Department of Anesthesiology and Intensive Care, University Hospital No. 1, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland

    Kinga Kupczyk

  12. Department of Intensive Care, CHU Rouen, Rouen, France

    Fabienne Tamion

  13. Centre de Recherche en Nutrition Humaine d’Auvergne (CRNH), CHU Clermont-Ferrand, Clermont-Ferrand, France

    Noël Cano

Authors
  1. Ronan Thibault
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  2. Anne-Marie Makhlouf
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  3. Aurélien Mulliez
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  4. M. Cristina Gonzalez
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  5. Gintautas Kekstas
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  6. Nada Rotovnik Kozjek
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  7. Jean-Charles Preiser
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  8. Isabel Ceniceros Rozalen
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  9. Sylvain Dadet
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  11. Kinga Kupczyk
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  12. Fabienne Tamion
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  13. Noël Cano
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  14. Claude Pichard
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Consortia

Phase Angle Project Investigators

  • Séverine Graf
  • , Claudia P. Heidegger
  • , Marcio Guerreiro
  • , Silvana Orlandi
  • , Andrius Klimasauskas
  • , Gintare Sostakaite
  • , Kristina Gorjup
  • , Katja Kogovšek
  • , Katja Kopriva Pirtovšek
  • , Michelle Norrenberg
  • , Karen Rizkallah
  • , François Wéry
  • , Ali Ait Hssain
  • , Bruno Pereira
  • , Bertrand Souweine
  • , Steven Grange
  • , Antoine Marchalot
  • , Pauline Bernier-Enguerrand
  • , Marlena Jakubczyk
  • , Aleksandra Różowicz
  • , Stanisław Kłęk
  •  & Ana Kunovic

Corresponding author

Correspondence to Ronan Thibault.

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Funding

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.

Additional information

Phase Angle Project Investigators are listed in the Acknowledgments.

Take-home message: The prospective observational study Phase Angle Project was performed in 931 patients (10 ICUs, nine countries). A low phase angle as measured by bioimpedance analysis at ICU admission is predictive of day 28 mortality. A multivariate combined score improves mortality prediction.

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Thibault, R., Makhlouf, AM., Mulliez, A. 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 42, 1445–1453 (2016). https://doi.org/10.1007/s00134-016-4468-3

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  • DOI: https://doi.org/10.1007/s00134-016-4468-3

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