Phase Angle and Frailty are Important Prognostic Factors in Critically Ill Medical Patients: A Prospective Cohort Study
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PHASE ANGLE AND FRAILTY ARE IMPORTANT PROGNOSTIC FACTORS IN CRITICALLY ILL MEDICAL PATIENTS: A PROSPECTIVE COHORT STUDY S.J. KO1,2, J. CHO1, S.M. CHOI1, Y.S. PARK1, C.-H. LEE1, S.-M. LEE1, C.-G. YOO1, Y.W. KIM1, J. LEE1 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea. Corresponding author: Jinwoo Lee, MD, Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, 03080, Republic of Korea; E-mail: [email protected]
Abstract: Objectives: To investigate whether phase angle (PhA) measured by bioelectrical impedance analysis (BIA) and frailty are associated with the outcomes of critical illnesses. Design: A single-center prospective cohort study. Setting: Medical intensive care unit (ICU) in Seoul National University Hospital, Seoul, Republic of Korea. Participants: 97 patients who were admitted to the medical ICU. Measurements: On admission, PhA was measured by BIA, and frailty was assessed by the Korean Modified Barthel Index (KMBI) scoring system. Patients were classified according to PhA and KMBI scores, and their impact on the outcomes of critical illnesses was evaluated. Results: The patients’ mean age was 62.4 ± 16.4 years, and 56 of the patients (57.7%) were men. Having a high PhA above 3.5 at the time of ICU admission was associated with lower in-hospital mortality (adjusted OR 0.42, p = .042), and a shorter duration of ICU stay (5.6 days vs. 9.8 days, p = .016) compared to those with a low PhA. Other indices measured by BIA were not significantly associated with outcomes of critical illnesses. Frailty (KMBI > 60) was associated with more mechanical ventilation days (2.3 days vs. 7.1 days; p = .018). Conclusion: Both PhA and frailty are important prognostic factors predicting the outcomes of critical illnesses. Low PhA scores were associated with increased mortality and a longer duration of ICU stay, and frailty was associated with more mechanical ventilation days. Key words: Bioelectrical impedance analysis, phase angle, frailty.
Introduction
proven to be an independent prognostic factor for several kind of cancers, including advanced lung and pancreatic, head and neck cancer (10–12), and breast cancer (13). A few studies have investigated the usefulness of PhA in critically ill patients and have revealed that low values of PhA were associated with higher mortality of patients in the ICU (8,14–20) or longer ICU stay (18,21). However, studies on critically ill medical patients in Asia are very rare (16,19,20). Although more elderly patients are being admitted to the ICU, age alone is an unreliable factor in predicting the prognosis of critical illnesses (22–24). Frailty is defined as a multi-dimensional syndrome characterized by the loss of physical and cognitive reserves, leading to increased vulnerability to
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