Nutrition Support Team, Casa de Saude Sao Jose - Rede Santa Catarina, Rio de Janeiro, Brazil; Postgraduate Program in Medical Science - Rio de Janeiro State University, Rio de Janeiro, Brazil.
Postgraduate Program in Health and Behavior - Catholic University of Pelotas, Pelotas, Brazil.
Nutrition. 2023 Jan;105:111852. doi: 10.1016/j.nut.2022.111852. Epub 2022 Sep 24.
The aim of this study was to ascertain the accuracy of phase angle (PhA) as a predictor of mortality during intensive care unit (ICU) stay (M) and at 28 (M) and 60 d (M) after ICU admission among patients aged >60 y.
Patients aged >60 y who were under mechanical ventilation (MV) ≥48 h were included once they were hemodynamically stable. PhA was measured by single-frequency bioelectrical impedance analysis up to 48 h after admission. ICU prognostic scores, functional scale, and nutritional assessments were performed in the first 24 h. Patients were followed for 60 d after ICU admission.
We enrolled 102 patients into the present study. PhA was significantly higher (P < 0.001) in survivors at M, M, and M. Areas under the receiving operator characteristic curves for M, M and M were 0.77 (95% confidence interval [CI], 0.67-0.86), 0.71 (95% CI, 0.60-0.82), and 0.71 (95% CI, 0.60-0.81), respectively. The PhA cutoff to predict mortality was 3.29° for males at M, M, and M and lower for females at M (2.63°) and M (3.01°). PhA better discriminated M than conventional prognostic scores. Logistic regression showed that even after controlling for other factors, PhA was a protective factor against late mortality. Survival analysis at 60 d revealed that low PhA was associated with lower median survival (18 versus 58 d; log-rank P < 0.001).
Low PhA values are associated with higher late mortality and a short survival time at 60 d in critically ill older adults. Low PhA values can be considered a useful ICU prognostic score in similar populations.
本研究旨在确定相位角（PhA）作为预测 60 岁以上患者重症监护病房（ICU）住院期间（M）和 ICU 入住后 28（M）和 60（M）天死亡率（M）的准确性。
纳入血流动力学稳定后机械通气（MV）≥48 小时的 60 岁以上患者。入院后 48 小时内通过单频生物电阻抗分析测量 PhA。在第 1 天至第 24 小时内进行 ICU 预后评分、功能量表和营养评估。对患者进行 ICU 入住后 60 天的随访。
本研究共纳入 102 例患者。M、M 和 M 时存活者的 PhA 显著较高（P<0.001）。M、M 和 M 的受试者工作特征曲线下面积分别为 0.77（95%置信区间[CI]，0.67-0.86）、0.71（95% CI，0.60-0.82）和 0.71（95% CI，0.60-0.81）。M、M 和 M 预测死亡率的 PhA 截断值分别为男性 3.29°，女性 M（2.63°）和 M（3.01°）较低。PhA 能更好地区分 M 与传统预后评分。Logistic 回归显示，即使在控制其他因素后，PhA 仍然是晚期死亡率的保护因素。60 天生存分析显示，低 PhA 与较低的中位生存时间相关（18 天与 58 天；对数秩检验 P<0.001）。
在危重病老年人中，低 PhA 值与较高的晚期死亡率和 60 天较短的生存时间相关。低 PhA 值可被视为类似人群中有用的 ICU 预后评分。
