title: Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project.
abstract: OBJECTIVE
  Phase angle as measured by bioelectrical impedance analysis reflects fat-free mass. Fat-free mass loss relates to worse prognosis in chronic diseases. Primary aim of this study was: to determine the association between fat-free mass at intensive care unit admission and 28-day mortality.
  
  
  METHODS
  Ten centres in nine countries participated in this multicentre prospective observational study. The inclusion criteria were age >18 years; expected length of stay >48 h; absence of pacemaker, heart defibrillator implant, pregnancy and lactation. Fat-free mass was assessed by measurement of the 50-kHz phase angle at admission. The primary endpoint was 28-day mortality. The area under the receiver operating characteristic curve (AUC) was used to assess prediction of 28-day mortality by fat-free mass at ICU admission. The variables associated with 28-day mortality were analysed by means of multivariable logistic regression.
  
  
  RESULTS
  Of the 3605 patients screened, 931 were analysed: age 61 ± 16 years, male 60 %, APACHE II 19 ± 9, body mass index 26 ± 6, day 1 phase angle 4.5° ± 1.9°. Day 1 phase angle was lower in patients who eventually died than in survivors (4.1° ± 2.0° vs. 4.6° ± 1.8°, P = 0.001). The day 1 phase angle AUC for 28-day mortality was 0.63 [0.58-0.67]. In multivariable analysis, the following were independently associated with 28-day mortality: age (adjusted odds ratio (aOR) 1.014 [95 % confidence interval 1.002-1.027], P = 0.03), day 1 phase angle (aOR 0.86 [0.78-0.96], P = 0.008), APACHE II (aOR 1.08 [1.06-1.11], P < 0.001), surgical patient (aOR 0.51 [0.33-0.79], P = 0.002), and admission for other diagnosis (aOR 0.39 [0.21-0.72], P = 0.003). A multivariable combined score improved the predictability of 28-day mortality: AUC = 0.79 [0.75-0.82].
  
  
  CONCLUSIONS
  Low fat-free mass at ICU admission is associated with 28-day mortality. A combined score improves mortality predictability.
  
  
  BACKGROUND
  NCT01907347 ( http://www.clinicaltrials.gov ).
authors: Nutrition Unit, Geneva University Hospitals, Geneva, Switzerland. ronan.thibault@chu-rennes.fr.|Nutrition Unit, Department of Endocrinology, Diabetology and Nutrition, INSERM U991, CHU Rennes-Université Rennes 1, 2, rue Henri Le Guilloux, 35000, Rennes, France. ronan.thibault@chu-rennes.fr.
authors: Ronan
authors: R
authors: Thibault
authors: Nutrition Unit, Geneva University Hospitals, Geneva, Switzerland.
authors: Anne-Marie
authors: AM
authors: Makhlouf
authors: Department of Biostatistics, Direction of Clinical Research and Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors: Aurélien
authors: A
authors: Mulliez
authors: Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.
authors: M
authors: M
authors: Cristina Gonzalez
authors: Department of Intensive Care, Vilnius University Hospital, Vilnius, Lithuania.
authors: Gintautas
authors: G
authors: Kekstas
authors: Clinical Nutrition Unit, Institute of Oncology, Ljubljana, Slovenia.
authors: Nada Rotovnik
authors: NR
authors: Kozjek
authors: Department of Intensive Care, Hôpital Universitaire Erasme, Brussels, Belgium.
authors: Jean-Charles
authors: JC
authors: Preiser
authors: Department of Intensive Care, Clinic USP Palmaplanas, Palma de Majorque, Spain.
authors: Isabel Ceniceros
authors: IC
authors: Rozalen
authors: Department of Nutrition, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors: Sylvain
authors: S
authors: Dadet
authors: Departement of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia.
authors: Zeljko
authors: Z
authors: Krznaric
authors: Department of Anesthesiology and Intensive Care, University Hospital No. 1, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
authors: Kinga
authors: K
authors: Kupczyk
authors: Department of Intensive Care, CHU Rouen, Rouen, France.
authors: Fabienne
authors: F
authors: Tamion
authors: Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH), CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors: Noël
authors: N
authors: Cano
authors: Nutrition Unit, Geneva University Hospitals, Geneva, Switzerland.
authors: Claude
authors: C
authors: Pichard
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001823:Body Composition; D015992:Body Mass Index; D016638:Critical Illness / Q000401:mortality*; D017097:Electric Impedance; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D000072878:Simplified Acute Physiology Score; D013997:Time Factors
keywords: Bioelectrical impedance analysis; Body composition; Critical care outcomes; Critical illness; Severity of illness index