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

R. Thibault (1, 2) , A.-M. Makhlouf (1) , A. Mulliez (3) , M. Cristina Gonzalez (4) , G. Kekstas (5) , N.R. Kozjek (6) , J.-C. Preiser (7) , I.C. Rozalen (8) , S. Dadet (3) , Z. Krznaric (9) , K. Kupczyk (10) , F. Tamion (11) , N. Cano (12, 3) , Capucine Pichard (1)

1 HUG - Hôpitaux Universitaires de Genève
2 Foie, métabolismes et cancer
3 CHU Clermont-Ferrand
4 UFPel - Universidade Federal de Pelotas = Federal University of Pelotas
5 Vilnius University Antakalnis Hospital
6 Institute of Oncology [Ljubljana]
7 ULB - Hôpital Erasme [Bruxelles]
8 Clinica Palmaplanas
9 Zagreb University Hospital
10 Nicolaus Copernicus University [Toruń]
11 CHU Rouen
12 CRNH d'Auvergne - Centre de Recherche en Nutrition Humaine d'Auvergne

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). © 2016, Springer-Verlag Berlin Heidelberg and ESICM.

Mots clés: Severity of illness index; Bioelectrical impedance analysis; Critical illness; Critical care outcomes; Body composition

Domaines: Hépatologie et Gastroentérologie; Cancer

R. Thibault, A.-M. Makhlouf, A. Mulliez, M. Cristina Gonzalez, G. Kekstas, 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 Medicine, 2016, 42 (9), pp.1445--1453. ⟨10.1007/s00134-016-4468-3⟩. ⟨hal-01373305⟩