Phase angle as a severity indicator for liver diseases

Ana Paula Pagano; Juliana Maria Faccioli Sicchieri; Isabela Laurencio Schiavoni; Daniel Barbeiro; Camila Sanches Manca; Bruna Ramos da Silva; Amanda Escobar Bezerra; Lívia Cristina Mendonça Pinto; Roberta Chaves Araújo; Andreza Correa Teixeira; Paula Garcia Chiarello

doi:10.1016/j.nut.2019.110607

Phase angle as a severity indicator for liver diseases

Nutrition. 2020 Feb:70:110607. doi: 10.1016/j.nut.2019.110607. Epub 2019 Oct 11.

Affiliations

¹ Hospital of Clinics, School of Medicine of Ribeirão Preto, Department of Internal Medicine, Division of Nutrition and Metabolism, University of São Paulo, Brazil. Electronic address: apaula.pagano@gmail.com.
² Hospital of Clinics, School of Medicine of Ribeirão Preto, Department of Internal Medicine, Division of Nutrition and Metabolism, University of São Paulo, Brazil.
³ Hospital of Clinics, School of Medicine of Ribeirão Preto, Department of Internal Medicine, Division of Gastroenterology, University of São Paulo, Brazil.

PMID: 31743810
DOI: 10.1016/j.nut.2019.110607

Abstract

Objective: The aim of this study was to evaluate the applicability of phase angle (PhA) as a severity indicator of chronic liver diseases.

Methods: We examined the medical records of 54 patients-27 with hepatocellular carcinoma (HCC) and 27 with non-alcoholic fatty liver disease (NAFLD). The patients were ≥18 y of age. Clinical data, such as Child-Pugh and Barcelona Clinic Liver Cancer (HCC), aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis (FIB)-4 (NAFLD), nutritional parameters (body mass index [BMI], handgrip strength [HGS], and bioelectrical impedance [BIA] data) were collected. Nutritional Risk Index (NRI) was calculated. Analysis was performed using Mann-Whitney test and analysis of variance. Simple multiple linear regression for predictions (Child-Pugh in HCC, APRI and FIB-4 in NAFLD). Receiver operating characteristic curve was estimated to search a cutoff for PhA. For survival, we used the Kaplan-Meier estimator. To verify whether PhA affected patients' survival, we used the Mantel-Haenszel.

Results: The prevalence of cirrhosis was high in HCC (n = 25) and low in the NAFLD (n = 4). No patient was classified as undernourished based on BMI; however, NRI showed that 74.1% of patients with HCC had nutritional risk. Child-Pugh was positively correlated with the edema index (extracellular water/total body water [ECW/TBW]) and negatively correlated with PhA and HGS. Higher Child-Pugh and BCLC scores were associated with worse NRI. APRI and FIB-4 were positively correlated with weight and BMI. A significant difference between groups was found for the median values of R, ECW/TBW, PhA, HGS, and albumin. There was a trend toward lower survival in patients with HCC, according to the cutoff point of 5.1 degrees for PhA.

Conclusion: PhA was shown to be an independent prognostic indicator for cirrhosis and may be related to survival in these patients.

Keywords: Bioeletrical impedance; Chronic liver diseases; Handgrip strength; Nutritional Risk Index; Phase angle.

Publication types

Evaluation Study

MeSH terms

Adult
Aged
Body Weight
Diet, Healthy / statistics & numerical data*
Electric Impedance*
End Stage Liver Disease / physiopathology*
Female
Hand Strength
Humans
Liver Function Tests / methods
Liver Function Tests / statistics & numerical data*
Male
Middle Aged
Muscle Strength
Nutrition Assessment
Nutritional Status
Predictive Value of Tests
Prognosis
Risk Assessment
Serum Albumin / analysis
Severity of Illness Index*

Substances

Serum Albumin