Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients
Malnutrition assessed by phase angle determines outcomes in low-risk cardiac surgery patients
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DOI：
10.1016/j.clnu.2016.02.010
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发表时间：
2016-12-01
影响因子：
6.3
通讯作者：
Ivaskevicius, Juozas
中科院分区：
文献类型：
--
作者：
Ringaitiene, Donata;Gineityte, Dalia;Ivaskevicius, Juozas
背景与目的：相位角（PA）是一种测量生物组织电学特性变化的非侵入性方法，是由生物电阻抗分析（BIA）得到的。它已被认为是疾病严重程度和虚弱的客观预后标志。本研究的目的是确定PA是否是低手术风险心脏手术患者营养不良和术后发病率的标志。方法：在某三级医院进行前瞻性研究。在预定手术前一天，应用BIA评估心脏手术患者的营养状况。应用选择标准，选择342例低手术风险患者，根据PA值分为低PA组和正常PA组。评估低PA与低无脂肪质量指数（FFMI）之间的相关性，FFMI是营养不良的标志。通过胸外科学会术后风险评估模型，分析低PA与术后不良结果之间的关系。评估低PA对ICU和住院时间的影响。结果：本组低PA患者61例（17.8%），其中低手术风险患者，Euroscore II中位值为1.46 (IQR: 0.97-2.03)，与FFMI相关，Pearson’s R为0.515 （p < 0.001）。单因素回归分析显示，低PA与较高的发生率（13[21.3%]对30 [10.7,6]p = 0.023）和术后发病率相关（OR = 2.27, Cl 95% = 1.10-4.66, p = 0.026）。此外，在校正术前术后发病率危险因素的多因素回归分析中，低PA仍然是一个独立因素（OR = 2.50, CI 95% 1.18-5.29, p = 0.016）。住院时间评估显示低PA组有延长住院时间（>14天）的趋势（31[50.8%]对105 [37.8%],p = 0.063）。结论：术前PA低是营养不良的一个指标，决定了心脏手术后的不良结局。需要进一步的研究来评估PA的临床应用，例如更准确地识别营养不良的心脏手术患者。(C) 2016爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background & aims: Phase angle (PA), which is obtained from bioelectrical impedance analysis (BIA), is a non-invasive method for measuring altered electrical properties of biological tissues. It has been recognised as an objective prognostic marker of disease severity and frailty. The aim of this study is to determine whether PA is a marker of malnutrition and postoperative morbidity in low operative risk patients undergoing cardiac surgery.Methods: A prospective study was conducted in a tertiary hospital. The nutritional state of the cardiac surgery patients was evaluated using BIA the day before the scheduled surgery. After applying selection criteria, 342 low operative risk patients were selected and classified into two groups in accordance with the PA value: a low PA group and a normal PA group. The correlation between low PA and low fat-free mass index (FFMI), a marker of malnutrition, was assessed. Associations between low PA and adverse postoperative outcomes, defined by the Society of Thoracic Surgeons postoperative risk evaluation model, were analysed. The impact of low PA on length of stay in an ICU and hospital was evaluated.Results: Low PA was detected in 61 (17.8%) patients in the selected group, which consisted of low operative risk patients with a median Euroscore II value of 1.46 (IQR: 0.97-2.03) and was associated with FFMI with Pearson's R of 0.515 (p < 0.001). Low PA was associated with higher rates (13 [21.3%] vs. 30 [10.7,6] p = 0.023) and risk of postoperative morbidity in univariate regression analysis (OR = 2.27, Cl 95% = 1.10-4.66, p = 0.026). Furthermore, low PA persisted as an independent factor in multivariate regression analysis (OR = 2.50, CI 95% 1.18-5.29, p = 0.016) adjusted for preoperative risk factors of postoperative morbidity. Evaluation of hospitalisation length revealed a tendency of a prolonged hospitalisation (>14 days) rate (31 [50.8%] vs. 105 [37.8%], p = 0.063) in the group with low PA.Conclusion: A low preoperative PA is an indicator of malnutrition and determines adverse outcomes after cardiac surgery. Further research is needed to evaluate clinical applications of the PA, such as a more accurate identification of malnourished cardiac surgery patients. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.