title: Evaluation of Bioelectrical Impedance Analysis in Critically Ill Patients: Results of a Multicenter Prospective Study.
abstract: 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.
  
  
  
  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 cm2for males and ≤110 cm2for 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Kuchnia
authors.affiliation: 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Earthman
authors.affiliation: 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA.
authors.forename: Levi
authors.initials: L
authors.lastname: Teigen
authors.affiliation: 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Cole
authors.affiliation: 2 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Mourtzakis
authors.affiliation: 2 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Paris
authors.affiliation: 3 Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Looijaard
authors.affiliation: 3 Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Weijs
authors.affiliation: 3 Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, the Netherlands.
authors.forename: Heleen
authors.initials: H
authors.lastname: Oudemans-van Straaten
authors.affiliation: 4 Division of Critical Care/Acute Care Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Beilman
authors.affiliation: 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Day
authors.affiliation: 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Leung
authors.affiliation: 6 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Charlene
authors.initials: C
authors.lastname: Compher
authors.affiliation: 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.affiliation: 7 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Peterson
authors.affiliation: 7 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Roosevelt
authors.affiliation: 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001823:Body Composition / Q000502:physiology*; D015992:Body Mass Index; D016638:Critical Illness; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D009133:Muscular Atrophy / Q000209:etiology*; D009752:Nutritional Status; D011446:Prospective Studies; D012372:ROC Curve; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: adult; bioimpedance; body composition; critical care; impedance ratio; life cycle; phase angle; research and diseases