Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study.
Phase Angle as a Biomarker for Frailty and Postoperative Mortality: The BICS Study.
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DOI：
10.1161/jaha.118.008721
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发表时间：
2018-09-04
影响因子：
5.4
通讯作者：
Afilalo J
中科院分区：
文献类型：
--
作者：
Mullie L;Obrand A;Bendayan M;Trnkus A;Ouimet MC;Moss E;Chen-Tournoux A;Rudski LG;Afilalo J
相角 (PA) 是一种生物阻抗测量值，用于确定去脂体重和水合状态。 PA 值低的患者更有可能身体虚弱、肌肉减少或营养不良。先前的研究表明，低 PA 可以预测心脏手术后的不良后果，但 PA 对生存的影响之前尚未在这种情况下进行评估。 BICS（心脏手术生物阻抗）研究招募了 277 名在加拿大魁北克省蒙特利尔市两家大学附属医院接受重大心脏手术的患者。术前进行生物阻抗测量以及虚弱和营养评估。主要结局是全因死亡率。次要结局是 30 天死亡率、术后发病率和住院时间。随访 1 个月时有 10 人死亡，随访 12 个月时有 16 人死亡。 PA 与年龄、性别、体重指数、合并症和虚弱有关，通过短期体能电池和弗里德量表进行测量。根据胸外科医生协会预测的死亡率进行调整后，较低的 PA 与 1 个月时较高的死亡率相关（调整后的优势比，PA 每降低 1°，死亡率为 3.57；95% 置信区间，1.35–9.47），12 个月时（调整后的优势比，PA 每降低 1°，死亡率为 3.03；95% 置信区间，1.30–7.09），风险较高。总体发病率（调整后的风险比，PA 每降低 1°，2.51；95% 置信区间，1.32–4.75），以及更长的住院时间（调整后的 β，PA 每降低 1° 4.8 天；95% 置信区间，1.3–8.2 天）。低 PA 与虚弱有关，可预测重大心脏手术后的死亡率、发病率和住院时间。需要进一步的工作来确定 PA 对旨在逆转衰弱的干预措施的反应。
Phase angle (PA) is a bioimpedance measurement that is determined lean body mass and hydration status. Patients with low PA values are more likely to be frail, sarcopenic, or malnourished. Previous work has shown that low PA predicts adverse outcomes after cardiac surgery, but the effect of PA on survival has not previously been assessed in this setting. The BICS (Bioimpedance in Cardiac Surgery) study recruited 277 patients undergoing major cardiac surgery at 2 university‐affiliated hospitals in Montreal, QC, Canada. Bioimpedance measurements as well as frailty and nutritional assessments were performed preoperatively. The primary outcome was all‐cause mortality. Secondary outcomes were 30‐day mortality, postoperative morbidity, and hospital length of stay. There were 10 deaths at 1 month of follow‐up and 16 deaths at 12 months of follow‐up. PA was associated with age, sex, body mass index, comorbidities, and frailty, as measured by the Short Physical Performance Battery and Fried scales. After adjusting for Society of Thoracic Surgeons–predicted mortality, lower PA was associated with higher mortality at 1 month (adjusted odds ratio, 3.57 per 1° decrease in PA; 95% confidence interval, 1.35–9.47) and at 12 months (adjusted odds ratio, 3.03 per 1° decrease in PA; 95% confidence interval, 1.30–7.09), a higher risk of overall morbidity (adjusted hazard ratio, 2.51 per 1° decrease in PA; 95% confidence interval, 1.32–4.75), and a longer hospital length of stay (adjusted β, 4.8 days per 1° decrease in PA; 95% confidence interval, 1.3–8.2 days). Low PA is associated with frailty and is predictive of mortality, morbidity, and length of stay after major cardiac surgery. Further work is needed to determine the responsiveness of PA to interventions aimed at reversing frailty.