Evaluation of Bioelectrical Impedance Analysis in Critically Ill Patients: Results of a Multicenter Prospective Study

Adam Kuchnia, Carrie Earthman, Levi Teigen, Abigail Cole, Marina Mourtzakis, Michael Paris, Willem Looijaard, Peter Weijs, Heleen Oudemans-Van Straaten, Gregory Beilman, Andrew Day, Roger Leung, Charlene Compher, Rupinder Dhaliwal, Sarah Peterson, Hannah Roosevelt, Daren K. Heyland

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Background: In critically ill patients, muscle loss is associated with adverse outcomes. Raw bioelectrical impedance analysis (BIA) parameters (eg, phase angle [PA] and impedance ratio [IR]) have received attention as potential markers of muscularity, nutrition status, and clinical outcomes. Our objective was to test whether PA and IR could be used to assess low muscularity and predict clinical outcomes. Methods: Patients (≥18 years) having an abdominal computed tomography (CT) scan and admitted to intensive care underwent multifrequency BIA within 72 hours of scan. CT scans were landmarked at the third lumbar vertebra and analyzed for skeletal muscle cross-sectional area (CSA). CSA ≤170 cm2 for males and ≤110 cm2 for females defined low muscularity. The relationship between PA (and IR) and CT muscle CSA was evaluated using multivariate regression and included adjustments for age, sex, body mass index, Charlson Comorbidity Index, and admission type. PA and IR were also evaluated for predicting discharge status using dual-energy x-ray absorptiometry-derived cut-points for low fat-free mass index. Results: Of 171 potentially eligible patients, 71 had BIA and CT scans within 72 hours. Area under the receiver operating characteristic (c-index) curve to predict CT-defined low muscularity was 0.67 (P ≤.05) for both PA and IR. With covariates added to logistic regression models, PA and IR c-indexes were 0.78 and 0.76 (P <.05), respectively. Low PA and high IR predicted time to live ICU discharge. Conclusion: Our study highlights the potential utility of PA and IR as markers to identify patients with low muscularity who may benefit from early and rigorous intervention.

Original languageEnglish (US)
Pages (from-to)1131-1138
Number of pages8
JournalJournal of Parenteral and Enteral Nutrition
Volume41
Issue number7
DOIs
StatePublished - Sep 1 2017

Bibliographical note

Funding Information:
Financial disclosure: Bodystat LTD (Isle of Man, UK) provided loaner Quadscan 4000 devices to each of the site collaborators, and a small research gift to C. Earthman. Support was provided to C. Earthman by the USDA National Institute of Food and Agriculture and the Minnesota Agricultural Experiment Station, Project MIN-18-104, Hatch Funding.

Keywords

  • adult
  • bioimpedance
  • body composition
  • critical care
  • impedance ratio
  • life cycle
  • phase angle
  • research and diseases

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