AUTHOR=Simón-Frapolli Víctor J. , Vegas-Aguilar Isabel M. , Fernández-Jiménez Rocío , Cornejo-Pareja Isabel M. , Sánchez-García Ana M. , Martínez-López Pilar , Nuevo-Ortega Pilar , Reina-Artacho Carmen , Estecha-Foncea María A. , Gómez-González Adela M. , González-Jiménez María B. , Avanesi-Molina Elma , Tinahones-Madueño Francisco J. , García-Almeida José M. 

TITLE=Phase angle and rectus femoris cross-sectional area as predictors of severe malnutrition and their relationship with complications in outpatients with post-critical SARS-CoV2 disease

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1218266

DOI=10.3389/fnut.2023.1218266

ISSN=2296-861X

ABSTRACT=Background&Aims: Malnutrition diagnosis in post-critical COVID-19 patients challenging due to the high prevalence of obesity and the variability and previously reported inconsistencies across current assessment methods. Bioelectrical-Impedance-Vectorial-Analysis (BIVA) with Phase Angle(PhA) and Nutritional Ultrasound (NU®) are emerging techniques which assess body composition with high precision in previous studies. Our study aims to determine the performance of PhA and Rectus-Femoris-Cross-Sectional-Area(RF-CSA) measurements in assessing body composition as part of the full-routinely morphofunctional assessment, and their capacity to predict severe malnutrition and assess complications and aggressive therapies requirement during recent Intensive-Care-Unit (ICU) admission, in a cohort of postcritically-ill COVID-19 outpatients. Methods: Prospective observational study including 75 outpatients. Correlations between all morphofunctional parameters and complications were analyzed. Multivariate logistic regression and ROC-curves assessed the performance of NU® and PhA predicting severe malnutrition. Differences in complications and aggressive therapies requirement using the cut-off points obtained were analyzed. Results:54.7% of patients were classified by Subjective-Global-Assessment(SGA) as SGA-B and 45.3% as SGA-C, while 78.7% met Global-Leadership-Initiative-of-Malnutrition (GLIM) criteria. PhA correlates positively with Body Cell Mass/height (BCM/h)(r=0.74), Skeletal Muscle Index (SMI)(r=0.29), RF-CSA(r=0.22), RF-Y axis(r=0.42), Handgrip Strenght (HGS)(r=0.42) and Barthel scale (r=0.29), and negatively with ICU stay(r=-0.48), total hospital stay (r=-0.57), invasive-mechanical-ventilation (IMV) requirement(r=-0.39), days of IMV(r=-0.41), tracheostomy requirement (r=-0.51) and number of prone maneuvers(r=-0.20). RF-CSA correlates positively with BCM/h(r=0.41), SMI(r=0.58), RF-Y axis(r=0.69), HGS(r=0.50) and Barthel scale(r=0.15), and negatively with total hospital stay (r=-0.22) and IMV requirement(r=-0.28). Cut-off points of PhA<5.4°, Standardized-Phase-Angle(SPhA)<-0.79, RF-CSA/h<2.52cm2/m (men) and <2.21cm2/m (women) showed good capacity predicting severe malnutrition according to SGA. PhA and SPhA cut-off points revealed differences in ICU stay, total hospital stay, number of prone manoeuvres, IMV and rehabilitation requirement, while RF-CSA/h cut-off points revealed differences in ICU stay and total hospital stay(p<0.05).Conclusion: more than 75% of patients presented malnutrition and around half were obese. PhA, SPhA, RF-CSA and RF-CSA/h, when assessing body composition in post-critical COVID-19 patients, showed moderate-to-high correlation with other morphofunctional parameters, good performance to predict severe malnutrition and to assess complications and aggressive therapies requirement during ICU admission.These parameters can help improve morphofunctional assessment of malnutrition in post-critical COVID-19 survivors, though more studies are needed in other populations.