title: Phase angle as a prognostic marker after percutaneous endoscopic gastrostomy (PEG) in a prospective cohort study.
abstract: OBJECTIVE
  The phase angle identifies changes in tissue's electrical properties assessed by bioelectrical impedance measurement and it can predict prognosis in some conditions. Percutaneous endoscopic gastrostomy (PEG) is commonly used in patients with severe nutritional problems, but there is a need to improve the clinical decision-making for using PEG. We examined if a decreased phase angle predicts complications, short-term mortality (within 60 days of PEG insertion), or inflammatory markers (high C-reactive protein [CRP] levels or low albumin levels) following PEG insertion.
  
  
  METHODS
  The phase angle was assessed from body resistance and reactance as measured by bioelectrical impedance in 131 patients admitted for PEG. Anthropometrics and clinical biochemical measures were collected at the time of PEG insertion, while complications and mortality were assessed at clinical follow-ups. Multivariable logistic regression analysis provided odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for sex, age, body mass index, and comorbidity.
  
  
  RESULTS
  A decreased phase angle did not statistically significantly increase the probability of acute complications or short-term mortality, but predicted increased inflammatory markers (CRP ≥10 mg/L [OR 1.63, 95% CI 1.02-2.60], albumin <30 g/L [OR 2.10, 95% CI 1.24-3.57] and a combination of CRP ≥10 mg/L and albumin <30 g/L [OR 3.06, 95% CI 1.51-6.19]).
  
  
  CONCLUSIONS
  A decreased phase angle did not predict acute complications or short-term mortality after PEG insertion, but predicted increased levels of inflammatory markers.
authors.affiliation: a Division of Surgical Care Science, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;|b Department of Biosciences and Nutrition , Karolinska Institutet, Karolinska University Hospital , Huddinge , Sweden ;|c Department of Clinical Nutrition and Dietetics , Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Lena
authors.initials: L
authors.lastname: Martin
authors.affiliation: d Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;|e Division of Cancer Studies , King's College London , London , UK ;
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.affiliation: f Department of Clinical Science, Intervention and Technology (CLINTEC) , Karolinska Institutet, Karolinska University Hospital , Huddinge , Sweden ;|g Center for Digestive Diseases , Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: John
authors.initials: J
authors.lastname: Blomberg
authors.affiliation: a Division of Surgical Care Science, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Asif
authors.initials: A
authors.lastname: Johar
authors.affiliation: h Department Clinical Nutrition at Sahlgrenska University Hospital , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bosaeus
authors.affiliation: a Division of Surgical Care Science, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;|e Division of Cancer Studies , King's College London , London , UK ;
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D002097:C-Reactive Protein
keywords: Complications; early mortality; enteral nutrition; malnutrition