Ângulo de fase da bioimpedância elétrica em indivíduos com 60 anos ou mais de idade, internados em uma Unidade de Terapia Intensiva: evolução clínica, gravidade da evolução e mortalidade

• Ano de defesa: 2021
• Autor(a) principal: Rosenfeld, Ricardo Schilling
• Outros Autores: [e-mail]
• Orientador(a): Lourenço, Roberto Alves
• Banca de defesa: Brandão, Andrea de Araújo , Cunha, Sergio da , Salluh, Jorge Ibrain Figueira
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências Médicas
• Departamento: Centro Biomédico::Faculdade de Ciências Médicas
• País: Brasil
• Palavras-chave em Português: Ângulo de fase; Escores prognósticos; Paciente idoso; Mortalidade; Doença crítica
• Palavras-chave em Inglês: Phase angle; Prognostic score; Mortality; Older patients; Critically ill
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::MEDICINA
• Link de acesso: http://www.bdtd.uerj.br/handle/1/19837

Objective: Evaluate the correlation of phase angle (PA) at the first 48 hours in the Intensive Care Unit (ICU) with prognostic scores and predict their association with mortality in ICU. The main study objective is the association between PA and late mortality. Methodology: Critically ill patients, ≥60 years of age, under mechanical ventilation (MV) ≥ 48 h, are study after hemodynamically stable. PA measured by a single frequency bioelectrical impedance (BIA). ICU severity prognostic and functional scales assessed in the first 24 hours. Patients followed until 60 days. Results: 102 patients are enrolled (mean age 79.9± 8.5 years, 51.0% female). Observed ICU mortality (MICU) and at 28 days (M28) is 36.6% and at 60 days (M60 ) is 41.2%. There is a significant correlation between PA and age (p<0.001), BMI (p<0.001), calf circumference (p<0.001), NRS (p=0.002) and Barthel index (p <0.001). Non-survivals demonstrate a lower PA at MICU (2.98o ± 0.76o X 3.77o ± 0.84o; p<0.001), M28 (3.07 o ± 0.79o X 3.72o ± 0.87o; p<0.001) and M60 (3.09o ± 0.81o X 3.77o ± 0.84o; p<0.001). PA’s AUC MICU, M28 and M60 were respectively 0.765 (CI95% 0.67-0.86), 0.709 (CI95% 0.60-0.82), and 0.708 (CI95% 0.60-0.81). A PA cutoff 3.29o is observed in all sample; lower in females at M28 (2.63o) and M60 (3.01o). The ROC curve for death on the 60th day shows that the predictive value of PA is better than the other prognostic and functional scores. Logistic regression showed PA reduction significantly associated with M60 (p=0.014). Survival analysis at 60 days, PA less than 3.01o for females and 3.29o for males was associated with lower median survival (18 days X 58 days; log-rank, p<0.001). Conclusion: Low PA values are associated with higher mortality. PA less than 3.29 for males and 3.01 for females are associated with short survival time at 60 days. The study presents original characteristics because it evaluates an estimator of mortality on older patients who receive critical care, which is little studied. PA could be included in the initial ICU’s routine as a marker of individual responsiveness to enable bedside decisions related to muscle mass and cellular health of older patients. PA’s values support decision-making for intensive or restrictive treatment intervention. Thus, it provides conditions for physicians and ICU teams to implement compassionate actions towards older people who do not respond or cannot respond to aggressive treatment due to worse cellular health.