Lee Gyeo Ra, Kim Eun Young
Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Front Med (Lausanne). 2023 Feb 22;10:1111727. doi: 10.3389/fmed.2023.1111727. eCollection 2023.
Bioelectrical impedance analysis (BIA) has advantages of obtaining results quickly, safely, reproducibly, and non-invasively. Phase angle (PhA) is one of the parameter of BIA, its values represent the permeability or integrity of cell membrane. With the exception of C-reactive protein (CRP), few studies have estimated an association between PhA and these conventional biomarkers. Herein, we aimed to investigate the association between the PhA value and the conventional inflammatory markers in postoperative patients in intensive care unit (ICU). Also, the correlation between the change in PhA and the occurrence of infectious complication were determined.
From July 2020 to February 2022, retrospective observation study conducted in 221 patients who admitted to ICU after abdominal surgery. BIA measurements and blood sampling were routinely performed the next morning. The relationship between PhA and the inflammatory markers were assessed after adjusting for age and body mass index. Univariate and multivariate logistic regression analysis was performed to examine the predisposing factors for postoperative infections.
Among 221 patients admitted to ICU after abdominal surgery, infectious complications occurred in 62 cases. CRP, procalcitonin, or presepsin levels were negatively correlated with PhA in both gender. (-0.295, -0.198 or -0.212 of partial correlation coefficients, respectively in males, and 0.313, -0.245 or -0.36 of partial correlation coefficients, respectively in females) But, white blood cell did not show significant association with PhA in both genders. For males, increased level of CRP on postoperative day 1 (POD1) was revealed as the significant predicting factor for postoperative infectious complication [odds ratio (OR): 1.184, 95% confidence interval (CI): 1.090-1.285, < 0.001]. For females, increased Acute Physiology and Chronic Health Evaluation II score at admission (OR: 1.457, 95% CI: 1.068-1.987, = 0.018), increased level of presepsin on (OR: 1.003, 95% CI: 1.001-1.006, = 0.016) and decreased value of PhA on POD1 (OR: 0.980, 95% CI: 0.967-0.993, = 0.003) were revealed as the significant predicting factors.
Phase angle obtained through BIA can be used as a predictor of infection as it shows a significant association with inflammatory markers. Phase angle measurements through BIA could improve patient prognosis after abdominal surgery through the careful observation of infections and early, appropriate treatment.
生物电阻抗分析（BIA）具有快速、安全、可重复且无创获取结果的优点。相角（PhA）是BIA的参数之一，其值代表细胞膜的通透性或完整性。除C反应蛋白（CRP）外，很少有研究评估PhA与这些传统生物标志物之间的关联。在此，我们旨在研究重症监护病房（ICU）术后患者的PhA值与传统炎症标志物之间的关联。此外，还确定了PhA变化与感染性并发症发生之间的相关性。
2020年7月至2022年2月，对221例腹部手术后入住ICU的患者进行回顾性观察研究。次日早晨常规进行BIA测量和血液采样。在调整年龄和体重指数后，评估PhA与炎症标志物之间的关系。进行单因素和多因素逻辑回归分析以检查术后感染的易感因素。
在221例腹部手术后入住ICU的患者中，62例发生了感染性并发症。CRP、降钙素原或 presepsin水平在两性中均与PhA呈负相关。（男性的偏相关系数分别为-0.295、-0.198或-0.212，女性分别为-0.313、-0.245或-0.36）。但是，白细胞在两性中均与PhA无显著关联。对于男性，术后第1天（POD1）CRP水平升高被揭示为术后感染性并发症的显著预测因素[比值比（OR）：1.184，95%置信区间（CI）：1.090-1.285，P<0.001]。对于女性，入院时急性生理与慢性健康状况评分II升高（OR：1.457，95%CI：1.068-1.987，P=0.018）、POD1时presepsin水平升高（OR：1.003，95%CI：1.001-1.006，P=0.016）以及POD1时PhA值降低（OR：0.980，95%CI：0.967-0.993，P=0.003）被揭示为显著预测因素。
通过BIA获得的相角可作为感染的预测指标，因为它与炎症标志物显示出显著关联。通过BIA进行相角测量可以通过仔细观察感染并进行早期、适当的治疗来改善腹部手术后患者的预后。
