Phase Angle, Lean Body Mass Index and Tissue Edema and Immediate Outcome of Cardiac Surgery Patients

NCT03644030 | Completed

• 1 other identifier: CardioMass
• Study Type: observational
• Target: 179
• Locations: 1 country
• Sites: 1

Brief Summary

In general, malnutrition in surgical patients is associated with a higher risk of postoperative infections, decreased immune response, more cardiac complications, prolonged mechanical ventilation , and a higher rate of reimportation due to several other complications than lead to an increase in morbidity and mortality, a prolongation of the total hospitalization time in the ICU\[intensive care unit \] and the chamber, and a delay in the healing of the surgical trauma . The presence of a low percentage of lean mass, as calculated by the technique of bioelectric conductivity, practically means a small percentage of muscle tissue. However, muscle tissue is an important, if not the only source of amino acids for both protein synthesis and gluconeogenesis in stress conditions, such as surgery and the first postoperative days. Thus, post-operative patients in general, and cardio-operated patients, in particular, having a low lean mass have minimal reserves to the stress requirements, resulting in an increased risk of complications. In the last few years, the most reliable indicator of malnutrition- in addition to the lean mass index - began to be considered the phase angle, which is also calculated when measuring the bioreduction of electrical conductivity, although there is a very recent challenge . The phase angle expresses the relationship between the electrical reactance, i.e. the state of the cell membrane, to resist the permeability and the resistance, i.e. the restriction to the flow of the electrical current through the body, mainly related to the water of the tissues . Like the FFM\[fat-free mass\]- index, the phase angle uses the total water of the tissues, and thus also reflects the cell mass. In addition, however, it also measures the resistance of cell membranes, so it also evaluates their quality and is therefore considered to be a reliable indicator of poor nutritional status , although some also maintain demur due to the possible poor distribution of extracellular fluid in cardiological patients. From all of the above, it appears that there are some gaps in the evaluation of the patients who are going to undergo cardiac surgery regarding their nutritional status, both because the classic nutrition control indicators are not fully documented as being reliable for these patients, and there are no studies to monitor and compare body composition directly to any other index postoperatively.

Conditions

Sarcopenia; Post-operative Infections; Sepsis

Keywords

FFM index; tissue edema index [extracellular / total water - ECW / TBW]; phase angle

Outcome Measures

Primary Outcomes (1)

• Phase angle in patients undergoing cardiac surgery as indicator of their nutrition status.

  Phase angle \[PhA(°) = (reactance/electrical resistance) × (180°/Π)\] will be measured in degrees using bioelectrical impedance analysis and check whether it can be considered as a reliable indicator of the nutrition status of cardiac surgery patients undergoing cardiac surgery during the preoperative and postoperative periods. PhA will be calculated by using the sum of impedance and reactance of the right arm, trunk, and right leg and based on the following equation, PhA(°) = (Reactance/Resistance) × (180°/Π). Π is the mathematical value of 3.1415 and This conversion is performed to convert the final value from radians into degrees.The normal range of phase angle is 5.84 ± 0.75.The primary change is the reduction of the mean phase angle postoperative by 1.0 unit (standard deviation ± 2.0) and this leads to increased morbidity, mortality.

  7 days post operation

Secondary Outcomes (2)

• FFM[fat-free mass] index(kilograms/(meter x meter)- kg/m-2) in patients undergoing cardiac surgery as indicator of their nutrition status

  7 days post operation

• Tissue edema index [extracellular(Litre) / total water(Litre) - ECW / TBW] in patients undergoing cardiac surgery as indicator of their nutrition status.

  7 days post operation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients scheduled to undergo cardiac surgery for coronary revascularization or valvular heart disease

You may qualify if:

• age \>18 years
• planned introduction for cardiac operation with CPB\[cardiopulmonary bypass\]
• coronary artery bypass surgery
• heart valve surgery \[heart valve surgery\]

You may not qualify if:

• non-consent of the patient
• urgent admissions - operations
• pacemaker exist
• congenital heart disease
• recent \[\<3-month\] open-heart surgery

Sponsors & Collaborators

• Aristotle University Of Thessaloniki: lead

Study Sites (1)

AHEPA University Hospital

Thessaloniki, 56346, Greece

Location

Related Publications (12)

• Visser M, van Venrooij LM, Vulperhorst L, de Vos R, Wisselink W, van Leeuwen PA, de Mol BA. Sarcopenic obesity is associated with adverse clinical outcome after cardiac surgery. Nutr Metab Cardiovasc Dis. 2013 Jun;23(6):511-8. doi: 10.1016/j.numecd.2011.12.001. Epub 2012 Mar 6.

  PMID: 22397879 BACKGROUND

• Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, Lomivorotov VN, Karaskov AM. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg. 2013 May;16(5):612-8. doi: 10.1093/icvts/ivs549. Epub 2013 Jan 29.

  PMID: 23360716 BACKGROUND

• Gomez-Perez SL, Haus JM, Sheean P, Patel B, Mar W, Chaudhry V, McKeever L, Braunschweig C. Measuring Abdominal Circumference and Skeletal Muscle From a Single Cross-Sectional Computed Tomography Image: A Step-by-Step Guide for Clinicians Using National Institutes of Health ImageJ. JPEN J Parenter Enteral Nutr. 2016 Mar;40(3):308-18. doi: 10.1177/0148607115604149. Epub 2015 Sep 21.

  PMID: 26392166 BACKGROUND

• Tsaousi G, Panidis S, Stavrou G, Tsouskas J, Panagiotou D, Kotzampassi K. Prognostic indices of poor nutritional status and their impact on prolonged hospital stay in a Greek university hospital. Biomed Res Int. 2014;2014:924270. doi: 10.1155/2014/924270. Epub 2014 Mar 23.

  PMID: 24779021 BACKGROUND

• van Venrooij LM, de Vos R, Borgmeijer-Hoelen MM, Haaring C, de Mol BA. Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery. Am J Clin Nutr. 2008 Jun;87(6):1656-61. doi: 10.1093/ajcn/87.6.1656.

  PMID: 18541553 BACKGROUND

• van Venrooij LM, de Vos R, Zijlstra E, Borgmeijer-Hoelen MM, van Leeuwen PA, de Mol BA. The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study. J Thorac Cardiovasc Surg. 2011 Nov;142(5):1263-9. doi: 10.1016/j.jtcvs.2011.07.033. Epub 2011 Aug 19.

  PMID: 21855896 BACKGROUND

• Visser M, van Venrooij LM, Wanders DC, de Vos R, Wisselink W, van Leeuwen PA, de Mol BA. The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients. Clin Nutr. 2012 Dec;31(6):981-6. doi: 10.1016/j.clnu.2012.05.002. Epub 2012 May 27.

  PMID: 22640476 BACKGROUND

• Tsaousi G, Kokkota S, Papakostas P, Stavrou G, Doumaki E, Kotzampassi K. Body composition analysis for discrimination of prolonged hospital stay in colorectal cancer surgery patients. Eur J Cancer Care (Engl). 2017 Nov;26(6). doi: 10.1111/ecc.12491. Epub 2016 Mar 16.

  PMID: 26990464 BACKGROUND

• Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ Jr, Couper GS, Allred EN, Cohn LH, Rizzo RJ. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg. 1999 Nov;118(5):866-73. doi: 10.1016/s0022-5223(99)70056-5.

  PMID: 10534692 BACKGROUND

• van Straten AH, Bramer S, Soliman Hamad MA, van Zundert AA, Martens EJ, Schonberger JP, de Wolf AM. Effect of body mass index on early and late mortality after coronary artery bypass grafting. Ann Thorac Surg. 2010 Jan;89(1):30-7. doi: 10.1016/j.athoracsur.2009.09.050.

  PMID: 20103201 BACKGROUND

• Wagner BD, Grunwald GK, Rumsfeld JS, Hill JO, Ho PM, Wyatt HR, Shroyer AL. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Ann Thorac Surg. 2007 Jul;84(1):10-6. doi: 10.1016/j.athoracsur.2007.03.017.

  PMID: 17588373 BACKGROUND

• Soeters PB, Schols AM. Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care. 2009 Sep;12(5):487-94. doi: 10.1097/MCO.0b013e32832da243.

  PMID: 19512916 BACKGROUND

MeSH Terms

Conditions

Sarcopenia; Sepsis

Condition Hierarchy (Ancestors)

Muscular Atrophy; Neuromuscular Manifestations; Neurologic Manifestations; Nervous System Diseases; Atrophy; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Infections; Systemic Inflammatory Response Syndrome; Inflammation; Pathologic Processes

Study Officials

• Katerina Kotzampassi

  Aristotle University Of Thessaloniki

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Surgeon Director of NSI

Study Record Dates

• First Submitted: August 11, 2018
• First Posted: August 23, 2018
• Study Start: September 6, 2018
• Primary Completion: August 15, 2019
• Study Completion: September 1, 2019
• Last Updated: September 9, 2019

Record last verified: 2018-09

Data Sharing

• IPD Sharing: Will not share

Locations

GR (1)