Performance evaluation of phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study

Six-month trajectory of phase angle after cardiovascular surgery and associated factors of the recovery during cardiac rehabilitation: A retrospective cohort study

BACKGROUND AND AIMS

Although the phase angle (PhA), a measure of frailty and sarcopenia, determined by bioelectrical impedance analysis has been reported as a prognostic factor after cardiovascular surgery, few studies have reported the trajectory of the PhA after discharge. In this study, we examined the trajectory of the PhA along with conventional physical function measures and explored the factors associated with recovery for 6 months after hospital discharge in patients who had undergone cardiovascular surgery.

METHODS

We included 116 patients who underwent elective cardiovascular surgery and cardiac rehabilitation after discharge. The PhA, physical function measures (grip strength, knee extension isometric muscle strength [KEIS], and usual gait speed), and Geriatric Nutritional Risk Index (GNRI) were assessed preoperatively, at discharge, and 3 and 6 months. Correlations between the PhA recovery rates and physical function and nutritional indices were assessed using Spearman's correlation analysis. Multivariate linear regression analysis was performed to examine the factors associated with recoveries of PhA and physical function indices (grip strength, KEIS, gait speed) after discharge.

RESULTS

Mean values of the PhA and physical function measurements and the GNRI score at discharge were lower than the preoperative values (PhA, -8.0 %; grip strength, -8.7 %; KEIS, -6.9 %; usual gait speed, -8.3 %; GNRI, -11 %). The grip strength, KEIS, and gait speed recovered to almost preoperative values 3 months after discharge. Values for the PhA and GNRI were still lower than preoperative values 3 months after discharge but had recovered to preoperative values at 6 months. The PhA was not significantly correlated with the recovery rates of the other indicators. Older age was negatively associated with PhA recovery rate, however, recovery rates decreased significantly with post-discharge physical activity.

CONCLUSIONS

In patients undergoing cardiovascular surgery, the PhA takes longer to recover than muscle strength or gait speed, requiring up to 6 months to recover to preoperative levels. Post-discharge interventions to increase daily physical activity may be an important method of speeding PhA recovery.

Preoperative bioelectrical impedance, measured phase angle, and hand-grip strength as predictors of postoperative outcomes in patients undergoing cardiac surgery: a systematic review

BACKGROUND

Postoperative problems are a major danger for patients after heart surgery. Predicting postoperative outcomes for cardiac surgery is limited by current preoperative evaluations. Handgrip strength (HGS) testing and bioelectrical impedance analysis (BIA) may provide extra ways to identify individuals at risk of surgical problems, enhancing risk assessment and results.

OBJECTIVE

The purpose of this systematic review is to assess the utility of measured phase angle (PA), HGS, and bioelectrical impedance as perioperative risk markers in adult patients undergoing elective heart surgery.

METHOD

The PRISMA principles were followed in this review. We searched all available electronic databases, including the Science Direct search engine and PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, CINAHL, Google Scholar, Scopus, and the Science Direct search engine, from their creation to the present, as well as the medRxiv pre-print site. We considered studies with adult subjects undergoing elective heart surgery who were monitored for problems after surgery and had perioperative BIA and HGS testing.

RESULTS

As a result, out of the 1544 pieces of research that were discovered, eight studies were deemed suitable for inclusion in the review and supplied data from 2781 people. The findings demonstrated a substantial correlation between poor preoperative PA and a higher risk of serious postoperative morbidity, as well as prolonged hospital stays. Furthermore, poor HGS and low PA were linked to greater death rates. Additionally, there was a strong correlation found between low PA and HGS and longer stays in the ICU, as well as an increased chance of dying from all causes in a year. In conclusion these results imply that preoperative HGS and PA may be significant indicators of postoperative results and may assist in identifying patients who are more vulnerable to problems and death.

Bioimpedance Spectroscopy in Heart Transplantation: Posttransplant Changes in Body Composition and Effects in Outcomes

BACKGROUND

Bioimpedance spectroscopy yields measurements of fat-free mass, fat mass, phase angle, and other measures. Bioimpedance spectroscopy has been validated as a preoperative assessment tool in cardiac surgical studies, in which low phase angle predicted morbidity and mortality. No studies have evaluated bioimpedance spectroscopy following heart transplantation.

METHODS

We evaluated body composition, nutrition status (Subjective Global Assessment, body mass index, midarm muscle circumference, and triceps skinfolds), and functional status (handgrip strength and 6-min walk test) in 60 adults. Body composition measurements via a 256-frequency bioimpedance spectroscopy device included fat and fat-free mass as well as phase angle calculated at 50 kHz. Testing was completed at baseline and 1, 3, 6, and 12 mo following heart transplantation. Mortality and hospital readmissions were analyzed.

RESULTS

Phase angle and fat mass increased while fat-free mass decreased; grip strength and 6-min walk test improved after transplantation (all P <  0.001). Improvement in phase angle in the first month postoperatively was associated with reduced risk of readmission. Low perioperative and 1-mo phase angles were associated with prolonged posttransplant length of stay (median: 13 versus 10 d, P =  0.03), increased infection-related readmissions (40% versus 5%, P =  0.001), and increased 4-y mortality (30% versus 5%, P =  0.01).

CONCLUSIONS

Phase angle, grip strength, and 6-min walk test distance improved after heart transplantation. Low phase angle appears to be associated with suboptimal outcomes and may be a feasible and affordable method to predict outcomes. Further research should ascertain whether preoperative phase angle can predict outcomes.

Combination of low muscle strength and malnutrition is associated with longer length of hospital stay among older patients with heart failure

BACKGROUND

Muscle strength and nutritional status are associated with length of hospital stay (LOHS) in older patients with heart failure (HF).

OBJECTIVES

The purpose of the study was to examine the association of the combination of muscle strength and nutritional status on LOHS in older patients with HF.

METHODS

This retrospective cohort study included 414 older inpatients with HF (men, 57.2%; median age, 81 years; interquartile range, 75-86 years). Patients were categorized into four groups according to their muscle strength and nutritional status: group 1, high muscle strength and normal nutritional status; group 2, low muscle strength and normal nutritional status; group 3, high muscle strength and malnutrition; and group 4, low muscle strength and malnutrition. The outcome variable was the LOHS, and an LOHS of >16 days was defined as long LOHS.

RESULTS

Multivariate logistic regression analysis adjusted for baseline characteristics (reference, group 1) showed that group 4 was associated with a more significant risk of long LOHS (odds ratio [OR], 3.54 [95% confidence interval, 1.85-6.78]). In the subgroup analysis, this relationship was maintained for the first admission HF group (OR, 4.65 [2.07-10.45]) but not for the HF readmission group (OR, 2.80 [0.72-10.90]).

CONCLUSIONS

Our results suggest that the long LOHS for older patients with HF at first admission was associated with a combination of low muscle strength and malnutrition but not by either factor individually.

Variations in phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study

BACKGROUND

Bioimpedance phase angle (PA) is a measure of cell membrane integrity, whereas handgrip strength (HGS) is an evaluation of functional capacity. Although both are related to the prognosis of patients undergoing cardiac surgery, their changes over time are less known. This study followed variations in PA and HGS for 1 year in these patients, determining associations with clinical outcomes.

METHODS

This prospective cohort study included 272 cardiac surgery patients. PA and HGS were measured at six predetermined times. The evaluated outcomes were surgery type; bleeding; time of surgery, cardiopulmonary bypass, aortic cross-clamp, and mechanical ventilation; postoperative (PO) length of stay (LOS) in the intensive care unit (ICU) and hospital; and infections, hospital readmission, reoperation, and mortality.

RESULTS

There were reductions in PA and HGS values after surgery, with total recovery beginning at 6 months for PA and 3 months for HGS. In the PA area under the curve (AUC), age, combined surgery, and sex (β = -9.66, P < 0.001; β = -252.85, P = 0.005; β = -216.56, P < 0.001, respectively) were predictors for PA-AUC reduction. Stratified by sex, age (β = -93.54, P < 0.001) and PO LOS (β = -46.91, P = 0.003) were predictors for HGS-AUC reduction in women, but only age was a predictor in men (β = -77.02, P = 0.010). PA and HGS had an effect in hospital LOS and ICU LOS.

CONCLUSION

Age, combined surgery, and female sex were predictors of reduced PA-AUC, whereas reduced HGS-AUC was predicted by age in both sexes and PO hospital LOS in women, which suggests that these factors could interfere in prognosis.

The Prognostic Value of Johns Hopkins Hospital Nutrition Support Score in Older Patients Undergoing Cardiovascular Surgery

OBJECTIVES

Clarify the prognostic value of the Johns Hopkins Hospital Nutrition Support (JHHNS) score on clinical outcomes in older patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB).

DESIGN

A retrospective observational study.

SETTING

A teaching and university hospital and tertiary referral center.

PARTICIPANTS

The authors analyzed 328 older patients aged ≥65 who underwent cardiovascular surgery with CPB in 2020.

INTERVENTIONS

Malnutrition risk was identified by the JHHNS score calculated based on specific preoperative and intraoperative objective parameters. Patients were divided into low- and high-JHHNS groups. Early morbidity, including pneumonia, bacteremia, wound infection, cerebrovascular accident, gastrointestinal bleeding, acute kidney injury, delirium, requirement for extracorporeal membrane oxygenation, and readmission to the intensive care unit (ICU), were the primary outcome; whereas in-hospital mortality, length of ICU and hospital stay, duration of mechanical ventilation and short-term mortality were secondary outcomes. The independent risk factors for postoperative complications were analyzed by logistic regression analyses.

MEASUREMENTS AND MAIN RESULTS

The JHHNS score identified 21.0% of patients at risk for malnutrition. Patients in the high-JHHNS group had prolonged median length hospital stay (21 v 24 days, p = 0.002) and mechanical ventilation (13.0 v 16.0 hours, p = 0.038), and more patients in this subgroup stayed longer than 3 days in ICU (30.1% v 43.5%, p = 0.036). Besides, they experienced more postoperative complications (11.2% v 39.1%, p < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that the JHHNS score independently predicted the risk of postoperative complications. No significant intergroup difference was observed for the short-term mortality.

CONCLUSIONS

The JHHNS score was an independent predictor for postoperative complications but did not significantly affect short-term mortality in older patients undergoing cardiovascular surgery with CPB.

Handgrip strength is associated with 12-month survival in male patients suffering with advanced chronic liver disease

BACKGROUND

Advanced chronic liver disease (ACLD) patients are usually malnourished, and both conditions in combination increase the likelihood of unfavourable clinical outcomes. Handgrip strength (HGS) has been suggested as a relevant parameter for nutritional assessment and predictor of adverse clinical outcomes in ACLD. However, the HGS cut-off values for ACLD patients have not yet been reliably established. The aims of this study were to preliminarily identify HGS reference values in a sample population of ACLD male patients and to assess their association with survival over a 12-month follow-up period.

METHODS

This was a prospective observational study with preliminary analysis of outpatients and inpatients. A total of 185 male patients with a medical diagnosis of ACLD met the inclusion criteria and were invited to participate in the study. The physiological variation in muscle strength related to the age of the individuals included in the study was considered to obtain cut-off values.

RESULTS

After categorising HGS by age group (adults: 18-60 years; elderly: ≥60 years), the reference values obtained were 32.5 kg for the adults and 16.5 kg for the elderly. During the 12-month follow-up, 20.5% of the patients died, and 76.3% of those had been identified with reduced HGS.

CONCLUSIONS

Patients with adequate HGS showed significantly higher 12-month survival than those with reduced HGS within the same period. Our findings show that HGS is an important predictive parameter for clinical and nutritional follow-up in ACLD male patients.

Phase Angle as a Potential Screening Tool in Adults with Metabolic Diseases in Clinical Practice: A Systematic Review

BACKGROUND

Phase angle (PhA) has been used as mortality prognostic, but there are no studies about its possible use as a screening tool. Therefore, an assessment of the possible utility of PhA in clinical practice is required. The aim of this systematic review was to explore all recent available evidence of PhA, and its possible utility as a screening tool in clinical practice in subjects with chronic metabolic diseases.

MATERIALS AND METHODS

This systematic review was performed and written as stated in the PRISMA 2020 guidelines. The search was conducted in PubMed, ScienceDirect and SciElo. In order to be considered eligible, within the entire search, only articles involving PhA and their utility in metabolic diseases were included.

RESULTS

PhA was associated with hyperuricemia and vitamin D deficiency in obese subjects, and decreased cardiovascular risk and malnutrition in hospitalized patients.

CONCLUSION

PhA may be a potential screening tool in clinical practice to evaluate different biomarkers, cardiovascular risk, and nutritional diagnosis in metabolic diseases in adults.

Muscle strength trajectories and their association with postoperative health-related quality of life in patients undergoing coronary artery bypass grafting surgery: a prospective cohort study

BACKGROUND

Patients with sarcopenia have a higher risk of poor recovery after coronary artery bypass grafting (CABG). Little is known about the impact of changes in muscle strength (the primary indicator for sarcopenia) on health-related quality of life (HR-QoL). This study aimed to (1) identify subgroups with different muscle strength trajectories, (2) identify differences in preoperative risk factors among trajectory group membership, and (3) explore their prognostic value on postoperative HR-QoL in patients undergoing CABG.

METHODS

In this prospective observational study 131 patients undergoing elective CABG completed grip strength tests and HR-QoL questionnaires. Latent Class Growth Mixture Modelling (LCGMM) was used to identify clinically relevant trajectories (> 5% of study population) for weight-normalised grip strength, measured at admission, 3 days, and 6 months after surgery. Differences between trajectory group membership at baseline were evaluated. The impact of trajectory group membership on postoperative HR-QoL was evaluated with multiple linear regression models.

RESULTS

Due to low numbers (n = 15), female patients were excluded from LCGMM and subsequent statistical analyses. In males (n = 116), we identified two main weight-normalised grip strength trajectories: a "stable average" trajectory with a slight decline immediately post-surgery and recovery to preoperative levels (n = 85) and a "high" trajectory with a considerable immediate decline after surgery but followed towards a higher level of recovery compared to preoperative level (n = 27). The "stable average" patients were older (68 vs. 57 years; P = 0.003), had more diabetes (27% vs. 4%; P = 0.01) and had a higher BMI (27.8 vs. 24.8; P = 0.005) compared to the "high" group. After correction for age, diabetes, and baseline HR-QoL, group trajectory membership was not associated with postoperative HR-QoL, yet an increase in individual change scores of weight-normalised grip strength was associated with a better postoperative HR-QoL. We also identified one small trajectory group (n = 4, ≤ 5%).

CONCLUSIONS

This study showed two relevant weight-normalised grip strength trajectories in male patients undergoing CABG, varying in important preoperative risk factors. While change scores of grip strength per weight did predict postoperative HR-QoL, the trajectory subgroups could not predict postoperative HR-QoL. Future research should focus on female patients, reacting potentially different on CABG and/or rehabilitation treatment. Trial registration NCT03774342, 12-12-2018.

Physical performance tests and in-hospital outcomes in elective open chest heart surgery

Background

Physical performance tests are essential for a comprehensive health assessment, and have been described as predictors of disability and muscle mass decline after open chest heart surgery (OHS). We evaluated the association between physical performance tests with clinical outcomes after OHS in younger and older patients. Moreover, the ability of physical performance tests and European System for Cardiac Operative Risk Evaluation (Euroscore II) to predict death was assessed.

Methods

Elective OHS patients were evaluated before surgery with handgrip strength (HGS), 30-s Chair-Stand Test (30sCST), and timed up and go test (TUGT). The outcomes were post-surgical complications, total length of stay (LOS), time to walk (TW), time in invasive mechanical ventilation (TIMV), and in-hospital mortality. Data were stratified between patients < 60 (younger) and ≥ 60 years old (older).

Results

A total of 166 patients were included in the study (older, n = 89). The only physical test associated with mortality in the adjusted models was HGS in older patients (p = 0.03). Among older patients, both Euroscore II (AUC = 0.77) and HGS (AUC = 0.80) demonstrated good ability to predict death. Combining HGS and Euroscore II did not increase accuracy for mortality prediction (AUC = 0.83).

Conclusion

HGS performance was comparable to a well-established surgical risk score in evaluating in-hospital mortality after OHS, only in older patients. Functional testing before OHS could be a tool to improve risk stratification in these patients. Future intervention studies aiming to improve functional capacity before elective OHS can further clarify the impact of physical fitness in surgical recovery.

Prognostic value of phase angle and bioelectrical impedance vector in critically ill patients: A systematic review and meta-analysis of observational studies

BACKGROUND AND AIMS

Assessment of the raw parameters derived from bioelectrical impedance analysis (BIA) has gained emphasis in critically ill patients. The phase angle (PhA) reflects the integrity of the cell membrane, and bioelectrical impedance vector analysis (BIVA) is indicative of patients' hydration status. The aim of this study was to investigate whether these parameters are associated with clinical outcomes in the intensive care unit (ICU) setting.

METHODS

We conducted a systematic review with meta-analysis. We searched PubMed, Embase, Scopus and Web of Science for all published observational studies without language restrictions up to April 2022. Two reviewers independently performed study selection and data extraction. We judged the risk of bias by the Newcastle-Ottawa Scale and the certainty of evidence by the GRADE approach. Mortality was the primary outcome. Secondary outcomes included ICU length of stay, hospital length of stay, duration of mechanical ventilation, nutritional risk, and malnutrition. A meta-analysis with a random-effect model was performed to combine data on R version 3.6.2.

RESULTS

Twenty-seven studies were included in the systematic review (4872 participants). Pooled analysis revealed that patients with low PhA had a higher risk of death (14 studies; RR = 1.82, 95% CI 1.46 to 2.26; I² = 42%) and spent more days in ICU (6 studies; MD = 1.79, 95% CI 0.33 to 3.24, I² = 69%) in comparison to patients with normal PhA. The pooled analysis also showed higher PhA values in survivors compared to non-survivor patients (12 studies; MD = 0.75°, 95% CI 0.60° to 0.91°, I² = 31%). Overhydration defined by BIVA was not a predictor of mortality (4 studies; RR = 1.01, 95% CI 0.70 to 1.46; I² = 0%). More than 40% of primary studies were classified with a high risk of bias, and the quality of evidence ranged from low to very low.

CONCLUSIONS

This meta-analysis revealed, with limited evidence, that low PhA was associated with higher mortality and ICU length of stay, while overhydration identified by BIVA was not a predictor of death in critically ill patients.

Phase angle of bioimpedance at 50 kHz is associated with cardiovascular diseases: systematic review and meta-analysis

The phase angle of bioimpedance is an important prognostic tool in clinical practice. The aim of this study was to investigate the association between phase angle and cardiovascular diseases. Electronic searches were carried out on MEDLINE, EMBASE, Cochrane, SCIELO, LILACS, CINAHL, Scopus, and the Web of Science. The PECO was "P" adults over 18 years of age, "E" the presence of cardiovascular disease, "C" absence of cardiovascular disease, and "O" phase angle values. The phase-angle means difference (MD) was analyzed separately by sex. Subgroup metanalysis with age, body mass index, and heart failure disease and meta-regressions were analyzed with random-effects models. Sensitivity analysis was performed considering only studies with high quality. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. Four-hundred-thirty-nine articles were identified, and 22 studies were included in this systematic review, totaling 10.010 participants. Eight studies met the criteria for the meta-analysis, involving 2164 participants. The phase angle (PA) was measured at 50 kHz frequency in all studies. Individuals with cardiovascular disease had a smaller PA compared to the control group, for both males (MD -0.70; 95% CI -1.01 to -0.39) and females (MD -0.76; 95% CI -1.39 to -0.13). In the sensitivity analysis, in men, the quality of studies (P < 0.01), and in women, heart failure (P < 0.01) was significantly different between groups.The values of the phase angle were lower in individuals with cardiovascular disease than in control subjects. This result reinforces the importance of this tool in clinical practice, highlighting its potential to assess health status. Registration: The systematic review protocol was registered in the PROSPERO database as CRD42020164178.

Association between phase angle and adverse clinical outcomes in hospitalized patients with COVID-19: A systematic review

Phase angle, obtained by bioelectrical impedance, is an indicator of cellular integrity and has been proposed as a prognostic parameter in patients who are critically ill. This systematic review aimed to evaluate the association between phase angle and adverse clinical outcomes in hospitalized patients with coronavirus disease–2019 (COVID‐19). An extensive literature search was performed in the MEDLINE/PubMed, Embase, and Web of Science databases, with interest in observational studies evaluating the association between phase angle and adverse clinical outcomes in individuals aged ≥18 years hospitalized with COVID‐19. Studies were independently selected by two reviewers, according to eligibility criteria. Subsequently, data were extracted and presented in a qualitative synthesis. The evaluation of the quality of the studies was performed according to the Newcastle‐Ottawa scale. The full methodology was published in PROSPERO (ID CRD42022306177). A total of 392 articles were identified, resulting in seven selected studies, of which six were prospective cohorts and one was retrospective. In the quality assessment, six studies obtained scores equal to or greater than seven, indicating a low risk of bias. A total of 750 participants composed the samples of the selected studies. Five studies reported an independent association between phase angle and adverse clinical outcomes during hospitalization for COVID‐19, with emphasis on prolonged hospitalization and mechanical ventilation and higher mortality in patients with a lower phase angle. Thus, phase angle measurement can be useful in the early identification of risks in patients hospitalized with COVID‐19, for the purpose of adequacy of clinical management.

Preoperative Phase Angle as a Risk Indicator in Cardiac Surgery-A Prospective Observational Study

Background: The phase angle (PhA) can be used for prognostic assessments in critically ill patients. This study describes the perioperative course of PhA and associated risk indicators in a cohort of elective cardiac surgical patients. Methods: The PhA was measured in 168 patients once daily until postoperative day (POD) seven. Patients were split into two groups depending on their median preoperative PhA and analyzed for several clinical outcomes; logistic regression models were used. Results: The PhA decreased from preoperative (6.1° ± 1.9°) to a nadir on POD 2 (3.5° ± 2.5°, mean difference −2.6° (95% CI, −3.0°; −2.1°; p < 0.0001)). Patients with lower preoperative PhA were older (71.0 ± 9.1 vs. 60.9 ± 12.0 years; p < 0.0001) and frailer (3.1 ± 1.3 vs. 2.3 ± 1.1; p < 0.0001), needed more fluids (8388 ± 3168 vs. 7417 ± 2459 mL, p = 0.0287), and stayed longer in the ICU (3.7 ± 4.5 vs. 2.6 ± 3.8 days, p = 0.0182). Preoperative PhA was independently influenced by frailty (OR 0.77; 95% CI 0.61; 0.98; p = 0.0344) and cardiac function (OR 1.85; 95%CI 1.07; 3.19; p = 0.028), whereas the postoperative PhA decline was independently influenced by higher fluid balances (OR 0.86; 95% CI 0.75; 0.99; p = 0.0371) and longer cardiopulmonary bypass times (OR 0.99; 95% CI 0.98; 0.99; p = 0.0344). Conclusion: Perioperative PhA measurement is an easy-to-use bedside method that may critically influence risk evaluation for the outcome of cardiac surgery patients.

Acute changes in handgrip strength, lung function and health-related quality of life following cardiac surgery

Background

Handgrip strength (HGS), lung function and health-related quality of life (HRQoL) are relevant indicators of future cardiovascular risk and mortality. The impact of cardiac surgery on these predictive variables has been under-explored. The aim of this study was to determine the acute (within hospital) changes in HGS, lung function and HRQoL, and their relationships, in adults undergoing elective cardiac surgery. Further, the study examined the relationship between these variables and the predictors for lung function and HRQoL in these patients.

Methods

The study was a prospective cohort study that involved 101 patients who completed pre-operative (1–2 days before surgery) and physiotherapy discharge (5–7 days after surgery) assessments. Handgrip strength, lung function and HRQoL were assessed using JAMAR dynamometers, Vitalograph-Alpha or EasyOne spirometer, and Short-Form 36 questionnaire, respectively. Changes in these variables and their relationships were analysed using paired t-test and Pearson correlation coefficients, respectively. Prediction of lung function and HRQoL using HGS and other co-variates was conducted using regression analysis.

Results

At the time of physiotherapy discharge, lung function, HGS and the physical component of HRQoL were significantly (<0.001) reduced compared to their pre-operative values. Significant (<0.001) and moderate correlations were identified between HGS and lung function at pre-operation and physiotherapy discharge. Handgrip strength was a significant predictor of lung function pre-operatively but not at physiotherapy discharge. Pre-operative lung function and HRQoL, as well as other variables, were significant predictors of lung function and HRQoL during physiotherapy discharge.

Conclusions

Undergoing cardiac surgery acutely and significantly reduced lung function, HGS and physical component of HRQoL in adults with cardiac disease. Assessment of HGS at physiotherapy discharge may be a poor indicator of operative changes in lung function and HRQoL. Clinicians may consider HGS as an inadequate tool in predicting lung function and HRQoL following cardiac surgery.

Association of phase angle with muscle strength and aerobic fitness in different populations: A systematic review

OBJECTIVES

The aim of this study was to summarize the evidence on the association of phase angle (PhA) with muscle strength and aerobic fitness in different populations.

METHODS

A systematic search on this topic was performed in nine electronic databases (CINAHL, LILACS, PubMed, SciELO, Scopus, SPORTDiscus, ScienceDirect, MEDLINE, and Web of Science) in January 2021. Studies with different designs that permitted extraction of information about the relationships between PhA and muscle strength and between PhA and aerobic fitness were included. A total of 4446 studies were initially identified; 34 were included after reading of the title, abstract, full text, and references. Four of the studies included had a longitudinal design, with samples consisting of participants ages 6 to 92 years. Thirty-two of the 34 studies evaluated the relationship between PhA and muscle strength, two cross-sectional studies investigated only PhA and aerobic fitness, and three cross-sectional studies evaluated both components (muscle strength and aerobic fitness).

RESULTS

PhA was directly associated with muscle strength in 30 cross-sectional studies and two longitudinal studies; the two studies that did not find a direct relationship had a cross-sectional design. For aerobic fitness, the five studies identified reported a direct relationship with PhA.

CONCLUSIONS

PhA is directly associated with muscle strength and aerobic fitness in different age groups (children, adolescents, adults, and older adults) and in people with different health conditions (human immunodeficiency virus, Crohn's disease, chronic obstructive pulmonary disease, bariatric surgery, kidney transplant, cancer, hemodialysis, and sarcopenia).

Prognostic Value of Handgrip Strength in Older Adults Undergoing Cardiac Surgery

BACKGROUND

Although multidimensional frailty scales have been proven to predict mortality and morbidity in cardiac surgery, there is a need for rapid tools that could be easily administered at the point of care. Handgrip strength (HGS) is an attractive option that can be measured in acutely ill and bed-bound patients, although it has yet to be validated in a large cardiac surgery cohort.

METHODS

This is a post hoc analysis of a multicentre prospective study in older patients undergoing coronary artery bypass grafting and/or valve surgery from 2011 to 2019. HGS was measured before surgery and classified by sex-stratified cutoffs. The primary outcome was 1-year mortality and secondary outcomes were 30-day mortality, discharge disposition, and prolonged length of stay.

RESULTS

There were 1245 patients included in the analysis (mean age 74.0 ± 6.6 years; 30% female). Weak HGS was associated with advanced age, heart failure, kidney disease, malnutrition, and various frailty scales. In those with weak vs normal HGS, respectively, 1-year mortality was 17% vs 6%, 30-day mortality was 10% vs 3%, prolonged length of stay was 34% vs 19%, and discharge to a health care facility was 45% vs 26% (all P < 0.001). After adjustment, HGS was predictive of 1-year and 30-day mortalities, with odds ratios of 2.44 (95% confidence interval [CI] 1.39-4.29) and 2.83 (1.38-5.81), respectively. HGS cutoffs of < 26 kg in men and < 16 kg in women had the highest predictive performance.

CONCLUSIONS

HGS is a simple and effective tool to identify patients at higher risk of mortality and protracted recovery after cardiac surgery.

Relationship between handgrip strength and lung function in adults: a systematic review

Handgrip strength (HGS) is a functional test that has been directly associated with lung function in some healthy populations; however, inconsistent findings have been reported for populations with chronic diseases. The aim of this study was to identify the relationship between HGS and lung function in both healthy and unhealthy adults. A systematic search was conducted using six databases from their earliest inception to February 29, 2020. Two authors reviewed and assessed methodological quality of eligible studies using the Crowe Critical Appraisal Tool (CCAT). Twenty-five studies met the inclusion criteria with 8 and 17 studies examining healthy and unhealthy populations, respectively. Reported average methodological quality of all included studies using the CCAT was 38-85% with most rated as Good to Excellent. Despite the use of heterogeneous equipment and protocols during HGS and lung function assessments, significant positive and moderate correlations and/or regression coefficients were reported for healthy populations consistently. Conversely, the reported relationships between HGS and lung function for unhealthy counterparts were variable. Handgrip strength was significantly associated with lung function in most healthy adults. Future robust studies are needed to confirm the suitability of HGS to assess lung function for healthy and unhealthy adults.

Phase Angle and Handgrip Strength as Complements to Body Composition Analysis for Refining Prognostic Accuracy in Cardiac Surgical Patients

OBJECTIVE

This study aimed to benchmark the prognostic validity of nutritional status, body composition, phase angle, and muscle strength assessment on the basis of morbidity and mortality in the cardiac surgery population.

DESIGN

Prospective, cohort study.

SETTING

Tertiary university hospital.

PARTICIPANTS

Patients undergoing cardiac surgery procedures.

INTERVENTIONS

Demographic, anthropometric, and clinical data registration, handgrip strength (HGS) measurement, and body composition assessment were performed the day before the scheduled surgery in a cohort of 179 cardiac surgery patients. Body composition parameters and HGS were reassessed on postoperative day seven (POD7). The study endpoints were the hospital length of stay (LOS) and in-hospital mortality.

RESULTS

Data from a cohort of 179 patients were analyzed. Significant impairment of nutritional status, body composition parameters, and HGS were recorded on POD seven (p < 0.001), which was associated with prolonged hospital LOS (p < 0.05). Postoperative low phase angle (PhA) (odds ratio [OR] 4.366; 95% confidence interval [CI] 1.859-10.255; p = 0.001), reduced fat-free mass index (OR 1.077; 95% CI 1.020-1.137; p = 0.008), and expanded extracellular water (ECW) (OR 1.230; 95% CI 1.080-1.401; p = 0.002) were the most powerful predictors of prolonged hospital LOS, with PhA (hazard ratio [HR] 1.228; 95% CI 1.074-1.403; p = 0.003) and ECW (HR 0.945; 95% CI 0.909-0.982; p = 0.004) serving as predictors of in-hospital mortality. Postoperative PhA, ECW, and total body water presented superior or at least equivalent discrimination of morbidity or mortality to EuroSCORE II.

CONCLUSIONS

Cardiac surgery patients are at risk of nutritional status deterioration during their hospitalization course, which, in turn, exerts an adverse effect on the outcome. Attenuation of PhA, deterioration of fat-free mass index, and edema development constitute potential surrogates to the prediction of morbidity and mortality.

Phase Angle Evaluation of Lung Disease Patients and Its Relationship with Nutritional and Functional Parameters

BACKGROUND

This study aimed to determine the value of phase angle (PhA) in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) and its association with nutritional and functional parameters.

METHODS

A cross-sectional study of 77 patients under follow-up at the pulmonary outpatient clinic of a public hospital. Anthropometric measurements and functional assessments of physical and pulmonary capacity were performed, and a regular physical activity questionnaire was administered.

RESULTS

The sample consisted of 38 patients with COPD (mean age, 63.8 ± 9.9 years; 68.4% female) and 39 patients with PH (mean age, 46.6 ± 14.4 years; 79.5% female). There was no difference in anthropometric measurements between patients with COPD and PH. Patients with COPD had mild to moderate limitations of pulmonary function, while patients with PH had only mild limitations (p < 0.01). Although the median distance covered in the 6-minute walk test (6MWT) was different between the COPD and PH groups (p < 0.05), it was considered adequate for these populations. Mean PhA was within the range considered adequate in patients with COPD (6.3°±1°) and PH (6.2°±0.8°) (p > 0.05). In the statistical analyses, although the correlations were weak, adequate PhA correlated with fat free mass index, 6MWT, disease staging, forced vital capacity, and forced expiratory volume in the first second.

CONCLUSION

The anthropometric profile of both patient groups was very similar, and PhA values were within the expected range. Despite weak correlations, PhA is a clinical component to be followed and investigated in patients with lung disease.