Department of Anesthesiology and ICU, Aristotle University Thessaloniki, Thessaloniki, Greece.
Department of Cardiosurgery, Aristotle University Thessaloniki, Thessaloniki, Greece.
J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2424-2431. doi: 10.1053/j.jvca.2020.10.037. Epub 2020 Oct 22.
This study aimed to benchmark the prognostic validity of nutritional status, body composition, phase angle, and muscle strength assessment on the basis of morbidity and mortality in the cardiac surgery population.
Prospective, cohort study.
Tertiary university hospital.
Patients undergoing cardiac surgery procedures.
Demographic, anthropometric, and clinical data registration, handgrip strength (HGS) measurement, and body composition assessment were performed the day before the scheduled surgery in a cohort of 179 cardiac surgery patients. Body composition parameters and HGS were reassessed on postoperative day seven (POD7). The study endpoints were the hospital length of stay (LOS) and in-hospital mortality.
Data from a cohort of 179 patients were analyzed. Significant impairment of nutritional status, body composition parameters, and HGS were recorded on POD seven (p < 0.001), which was associated with prolonged hospital LOS (p < 0.05). Postoperative low phase angle (PhA) (odds ratio [OR] 4.366; 95% confidence interval [CI] 1.859-10.255; p = 0.001), reduced fat-free mass index (OR 1.077; 95% CI 1.020-1.137; p = 0.008), and expanded extracellular water (ECW) (OR 1.230; 95% CI 1.080-1.401; p = 0.002) were the most powerful predictors of prolonged hospital LOS, with PhA (hazard ratio [HR] 1.228; 95% CI 1.074-1.403; p = 0.003) and ECW (HR 0.945; 95% CI 0.909-0.982; p = 0.004) serving as predictors of in-hospital mortality. Postoperative PhA, ECW, and total body water presented superior or at least equivalent discrimination of morbidity or mortality to EuroSCORE II.
Cardiac surgery patients are at risk of nutritional status deterioration during their hospitalization course, which, in turn, exerts an adverse effect on the outcome. Attenuation of PhA, deterioration of fat-free mass index, and edema development constitute potential surrogates to the prediction of morbidity and mortality.
本研究旨在基于心脏手术患者的发病率和死亡率，对营养状况、身体成分、相位角和肌肉力量评估的预后有效性进行基准测试。
前瞻性队列研究。
三级大学医院。
接受心脏手术的患者。
在接受心脏手术的 179 名患者的队列中，在预定手术前一天进行人口统计学、人体测量学和临床数据登记、握力（HGS）测量和身体成分评估。在术后第 7 天（POD7）重新评估身体成分参数和 HGS。研究终点为住院时间（LOS）和住院死亡率。
对 179 名患者的队列数据进行了分析。在术后第 7 天（p<0.001）记录到营养状况、身体成分参数和 HGS 显著受损，与住院时间延长相关（p<0.05）。术后低相位角（PhA）（比值比 [OR] 4.366；95%置信区间 [CI] 1.859-10.255；p=0.001）、减少的无脂肪质量指数（OR 1.077；95% CI 1.020-1.137；p=0.008）和扩大的细胞外液（ECW）（OR 1.230；95% CI 1.080-1.401；p=0.002）是延长住院时间的最强预测因子，PhA（风险比 [HR] 1.228；95% CI 1.074-1.403；p=0.003）和 ECW（HR 0.945；95% CI 0.909-0.982；p=0.004）是住院死亡率的预测因子。术后 PhA、ECW 和总体水在预测发病率或死亡率方面表现出优于或至少等同于 EuroSCORE II 的区分能力。
心脏手术患者在住院期间存在营养状况恶化的风险，这反过来又对预后产生不利影响。PhA 衰减、无脂肪质量指数恶化和水肿发展构成发病率和死亡率预测的潜在替代指标。
