Author/Editor     Thibault, Ronan; Makhlouf, Anne-Marie; Mulliez, Aurélien; Gonzalez, M. Cristina; Kekstas, Gintautas; Rotovnik-Kozjek, Nada; Preiser, Jean-Charles; Ceniceros Rozalen, Isabel; Dadet, Sylvain; Krznarić, Željko; Kupczyk, Kinga; Tamion, Fabienne; Cano, Noël; Pichard, Claude
Title     Fat-free mass at admission predicts 28-day mortality in intensive care unit patients
Type     članek
Vol. and No.     Letnik 42, št. 9
Publication year     2016
Volume     str. 1445-1453
ISSN     0342-4642 - Intensive care medicine
Language     eng
Abstract     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 4.5⁰ % 1.9⁰. Day 1 phase angle was lower in patients who eventually died than in survivors (4.1⁰ % 2.0⁰ vs. 4.6⁰ % 1.8⁰, 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.
Keywords     bioelektrična impendanca
analiza
telesna sestava
intenzivna nega
body composition
bioelectrical impedance analysis
critical care outcomes