Usefulness of the phase angle for inflammation criteria of the global leadership initiative on malnutrition in critically ill patients.

Abstract

Background: The Global Leadership Initiative on Malnutrition (GLIM) is an international nutritional assessment approach, but its evaluation for reduced muscle mass and inflammation criteria remain undefined in critically ill patients. We hypothesize that the phase angle derived from a bioelectrical impedance analysis (BIA) may be used as a GLIM inflammation criterion.

Methods: ICU patients expected to require ≥ 48 h of mechanical ventilation were stratified by the median phase angle. The primary outcomes were in-hospital mortality and the Barthel Index at discharge. Phase angle cut-off values were calculated for in-hospital death and the composite outcome of death or discharge with a Barthel Index < 70. Outcomes were compared between groups using the BIA-based GLIM (phase angle and skeletal muscle index) and the GLIM assessed by C-reactive protein (CRP) and computed tomography (CT).

Results: Fifty-three patients were included. The phase angle was significantly associated with hospital stay and mechanical ventilation duration. The areas under the ROC curve of the phase angle for mortality and a Barthel Index < 70 were higher than those for SOFA, APACHE II and maximum CRP. The BIA-based GLIM identified malnourished patients with significantly poorer prognoses than CRP/CT-based GLIM. With phase angle thresholds of 2.67 and 4.03, the GLIM malnutrition showed a longer hospital stay, lower grip strength at discharge.

Conclusion: The phase angle might be a suitable indicator for inflammation in the GLIM criteria, and appropriate BIA equipment providing both the phase angle and SMI might allow the initial assessment to be completed in a single step.