Diagnostic performance of brain Natriuretic Peptide, Bioelectrical Impedance Analysis, and Left Ventricular End-Diastolic Diameter in the Determination of Fluid Overload and Mortality In Pediatric Sepsis

Objective@#This pilot study investigated whether serum B-type Natriuretic Peptide (BNP), bioelectrical impedance analysis (BIA), and left ventricular end-diastolic diameter (LVEDD) can be used to predict fluid overload and clinical outcomes in pediatric sepsis. @*Methods@#Pediatric sepsis patients were enrolled. BNP, BIA, and LVEDD were obtained on admission and on Day 3. Diagnostic performances of BNP, BIA, LVEDD and correlation with fluid status were obtained.@*Results@#Twenty-two patients were enrolled. Day 3 BNP was higher in non-survivors (9241 vs. 682.2 pg/mL, p=0.04) and day 3 LVEDD Z-score was lower in non-survivors (-3.51 vs. -0.01, p=0.023). There was no difference in the fluid balance between survivors and non-survivors. Admission BNP >670.34pg/mL predicted vasopressor use with a sensitivity of 85.71% and specificity of 86.67% while ΔBNP>5388.13pg/mL predicted mortality with 100% sensitivity. Day 3 LVEDD <22mm predicted mortality with a sensitivity of 94.74%. Cumulative fluid balance was strongly correlated with BIA and LVEDD (r=0.65, p=0.001; r=0.74, p<0.001 respectively). The median length of stay in hospital days for non-survivors was not significantly different from survivors (4 [1-12] vs. 8 [6-12] days,p=0.21). @*Conclusion@#Rise in BNP levels appear to be independent of fluid status and is a good predictor of mortality, vasopressor, and mechanical ventilator use but not of length of hospital stay. LVEDD and BIA are good estimates of cumulative fluid balance but not as predictors of mortality, vasopressor, mechanical ventilator use, and length of hospital stay. Significance of the outcomes of the study was limited due to the small sample size.

Clinical usefulness of bioimpedance analysis for assessing volume status in patients receiving maintenance dialysis

Chronic volume overload is associated with left ventricular hypertrophy and high cardiovascular mortality in patients undergoing dialysis. Therefore, estimating body fluid status is important in these patients. However, most dry-weight assessments are still performed clinically, while attempts have been made to measure the volume status and dry weight of patients undergoing dialysis using bioimpedance analysis (BIA). BIA uses the electrical properties of the human body to alternate current flow and measures resistance values to estimate body water content and composition. BIA is divided into single-frequency BIA, multi-frequency BIA, and bioimpedance spectroscopy (BIS) according to the number of frequencies used, and into whole-body and segmental BIA according to whether or not the whole body is divided into segments. Extracellular water (ECW), intracellular water, and total body water (TBW) contents can be measured with BIA. Dry weight can be estimated by measuring the volume overload of the patient through the ECW/TBW and ECW-to-body weight ratios. Other estimation methods include the normovolemia/hypervolemia slope method, a resistance-reactance (RXc) graph, overhydration measurements using a body composition monitor, and calf BIS. In this review, we will examine the principles of BIA, introduce various volume status measurement methods, and identify the optimal method for patients undergoing dialysis.

Bioimpedance as a tool for evaluating the body composition of suruvi (Steindachneridion scriptum)

Abstract Bioelectrical impedance analysis (BIA) is regarded as an important tool for evaluating the body composition of different animals in a rapid, non-destructive, and low-cost manner. A South American fish species, Steindachneridion scriptum, known as suruvi, was selected for study in this investigation. A protocol to produce fish with different body composition was used to allow BIA to adequately predict the body composition of suruvi. The fish were fed twice each day with two different diets; a low lipid diet (8.90%), and a high lipid diet (18.68%). These dietary differences allowed suruvi specimens with different body compositions to be produced. The BIA readings were determined using a Quantum X Bioelectrical Body Composition Analyzer. Two readings (dorsal and ventral) were obtained for each fish. After BIA readings were obtained, the proximate composition of the fish bodies for each individual was determined. All of the study data were used to establish correlation equations between proximate analyses and BIA values. Strong correlations were found for S. scriptum. The highest correlations were obtained for the following pairs of quantities, using BIA data from dorsal readings: moisture and resistance in series (R2 = 0.87); protein and resistance in series (R2 = 0.87); and ash and reactance in parallel (R2 = 0.82). We conclude that BIA is an effective method in determining the body composition of S. scriptum without sacrificing the fish. However, to expand the use of this new technology it is important to define strict BIA protocols to guarantee accurate estimates.

Resumo A análise da impedância bioelétrica (BIA) é considerada uma importante ferramenta para avaliar a composição corporal de diferentes animais de uma maneira rápida, não-destrutiva e de baixo custo. A espécie Sul-americana Steindachneridion scriptum, popularmente conhecida como suruvi, foi selecionada para este estudo. Foi utilizado um protocolo para produzir peixes com distintas composições corporais, permitindo a validação da BIA para análise adequada da composição corporal do suruvi. Os peixes foram alimentados duas vezes ao dia com duas dietas diferentes: uma de baixo teor lipídico (8,90%) e outra de alto teor lipídico (18,68%). Essa diferença nas dietas possibilitou a produção de indivíduos com diferentes composições corporais. As leituras da BIA foram determinadas utilizando-se o equipamento Quantum X Bioelectrical Body Composition Analyzer. Duas leituras (dorsal e ventral) foram obtidas para cada peixe. Após as leituras, para cada peixe individualmente, a composição proximal dos peixes foi determinada. Todos os dados obtidos foram utilizados para estabelecer as equações de correlação entre as análises proximais e os valores da BIA. Fortes correlações foram encontradas para S. scriptum. As maiores correlações foram obtidas para as análises dorsais a seguir: umidade e resistência em série (R2 = 0,87); proteína e resistência em série (R2 = 0,87); cinzas e reactância em paralelo (R2 = 0,82). Pode-se concluir que o método BIA é eficiente em determinar a composição corporal do suruvi S. scriptum sem sacrificar o animal. No entanto, para expandir o uso desta nova tecnologia é necessário definir protocolos rigorosos para garantir estimativas precisas.

Bioimpedance as a tool for evaluating the body composition of suruvi (Steindachneridion scriptum) / Bioimpedância como ferramenta de análise da composição corporal do suruvi (Steindachneridion scriptum)

Abstract Bioelectrical impedance analysis (BIA) is regarded as an important tool for evaluating the body composition of different animals in a rapid, non-destructive, and low-cost manner. A South American fish species, Steindachneridion scriptum, known as suruvi, was selected for study in this investigation. A protocol to produce fish with different body composition was used to allow BIA to adequately predict the body composition of suruvi. The fish were fed twice each day with two different diets; a low lipid diet (8.90%), and a high lipid diet (18.68%). These dietary differences allowed suruvi specimens with different body compositions to be produced. The BIA readings were determined using a Quantum X Bioelectrical Body Composition Analyzer. Two readings (dorsal and ventral) were obtained for each fish. After BIA readings were obtained, the proximate composition of the fish bodies for each individual was determined. All of the study data were used to establish correlation equations between proximate analyses and BIA values. Strong correlations were found for S. scriptum. The highest correlations were obtained for the following pairs of quantities, using BIA data from dorsal readings: moisture and resistance in series (R2 = 0.87); protein and resistance in series (R2 = 0.87); and ash and reactance in parallel (R2 = 0.82). We conclude that BIA is an effective method in determining the body composition of S. scriptum without sacrificing the fish. However, to expand the use of this new technology it is important to define strict BIA protocols to guarantee accurate estimates.

Resumo A análise da impedância bioelétrica (BIA) é considerada uma importante ferramenta para avaliar a composição corporal de diferentes animais de uma maneira rápida, não-destrutiva e de baixo custo. A espécie Sul-americana Steindachneridion scriptum, popularmente conhecida como suruvi, foi selecionada para este estudo. Foi utilizado um protocolo para produzir peixes com distintas composições corporais, permitindo a validação da BIA para análise adequada da composição corporal do suruvi. Os peixes foram alimentados duas vezes ao dia com duas dietas diferentes: uma de baixo teor lipídico (8,90%) e outra de alto teor lipídico (18,68%). Essa diferença nas dietas possibilitou a produção de indivíduos com diferentes composições corporais. As leituras da BIA foram determinadas utilizando-se o equipamento Quantum X Bioelectrical Body Composition Analyzer. Duas leituras (dorsal e ventral) foram obtidas para cada peixe. Após as leituras, para cada peixe individualmente, a composição proximal dos peixes foi determinada. Todos os dados obtidos foram utilizados para estabelecer as equações de correlação entre as análises proximais e os valores da BIA. Fortes correlações foram encontradas para S. scriptum. As maiores correlações foram obtidas para as análises dorsais a seguir: umidade e resistência em série (R2 = 0,87); proteína e resistência em série (R2 = 0,87); cinzas e reactância em paralelo (R2 = 0,82). Pode-se concluir que o método BIA é eficiente em determinar a composição corporal do suruvi S. scriptum sem sacrificar o animal. No entanto, para expandir o uso desta nova tecnologia é necessário definir protocolos rigorosos para garantir estimativas precisas.

Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

BACKGROUND: Bioimpedance analysis (BIA) helps measuring the constituents of the body noninvasively. Prior studies suggest that BIA-guided fluid assessment helps to predict survival in dialysis patients. We aimed to evaluate the clinical usefulness of BIA for predicting the survival rate of hemodialysis patients in Korea. METHODS: We conducted a single-center retrospective study. All patients were diagnosed with end-stage renal disorder and started maintenance hemodialysis between June 2009 and April 2014. BIA was performed within the 1st week from the start of hemodialysis. The patients were classified into 2 groups based on volume status measured by the body composition monitor (BCM; Fresenius): an overhydrated group [OG; overhydration/extracellular water (OH/ECW) >15%] and a nonoverhydrated group (NOG; OH/ECW < or =15%). RESULTS: A total of 344 patients met the inclusion criteria. Of these, 252 patients (73.3%) were categorized into the OG and 92 patients (26.7%) into the NOG. Age- and sex-matching patients were selected with a rate of 2:1. Finally, 160 overhydrated patients and 80 nonoverhydrated patients were analyzed. Initial levels of hemoglobin and serum albumin were significantly lower in the OG. During follow-up, 43 patients from the OG and 7 patients from the NOG died (median follow-up duration, 24.0 months). The multivariate-adjusted all-cause mortality was significantly increased in the OG (odds ratio, 2.569; P = 0.033) and older patients (odds ratio, 1.072/y; P < 0.001). No significant difference of all-cause or disease-specific admission rate was observed between the 2 groups. CONCLUSION: The ratio of OH/ECW volume measured with body composition monitor is related to the overall survival of end-stage renal disorder patients who started maintenance hemodialysis.

Use of Bioelectrical Impedance Analysis for Nutritional Treatment in Critically Ill Patients

Patients in the intensive care unit (ICU) easily have large amounts of extracellular fluids, such as edema or ascites, because of cardiovascular instability under septic conditions and also have high risk of malnutrition while staying in the ICU. Traditional nutritional assessment parameters like body mass index have a limitation in ICU patients due to muscle atrophy and decrease of lean body mass. Bioimpedence analyses (BIA) can be used to assess body composition and are useful in performance of nutritional assessments in ICU patients. BIA can simply and noninvasively estimate body composition (total body water, extracellular water, intracellular water, body cell mass, and free fat mass etc.) by sending a weak electric current through the body. In particular, phase angle (PhA, phase difference between the voltage applied to the impedance and the current driven through it), one of the parameters of BIA, is related to cell membrane integrity or cell size. Low PhA can possibly imply malnutrition and PhA has been reported as a useful indicator of clinical outcomes or prognosis of severe patients. Additional study with clinical application of BIA in ICU patients is needed in order to confirm the usefulness of BIA.

Prediction of Treatment Outcome with Bioimpedance Measurements in Breast Cancer Related Lymphedema Patients

OBJECTIVE: To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. METHOD: Unilateral BCRL patients who received complex decongestive therapy (CDT) for 2 weeks (5 days per week) were enrolled in this study. We measured the ratio of extracellular fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before treatment. Arm circumferences were measured at 10 cm above and below the elbow before and after treatment. We also investigated whether there is correlation between ECF ratio and SFBIA ratio with the change of arm circumference after CDT. RESULTS: A total of 73 patients were enrolled in this study. The higher ECF ratio was significantly correlated with higher reduction of arm circumference at both above and below the elbow after treatment, but the higher SFBIA ratio was correlated only with the higher reduction of arm circumference below the elbow. CONCLUSION: These results show that ECF volume measurements and SFBIA before treatment are useful tools for predicting the outcome of patients with lymphedema. We concluded that ECF volume measure can be used as a screening tool for predicting treatment outcome of BCRL patients.

Comparisons of obesity assessments in over-weight elementary students using anthropometry, BIA, CT and DEXA

Obesity was characterized in Korean elementary students using different obesity assessment tests on 103 overweight elementary students from three schools of Jeonbuk Province. The body mass index (BMI) and obesity index (OI) were compared, and the data using DEXA and CT were compared with the data using BIA and a tape measure. The results of this study are as follows: first, 27 students who were classified as obese by OI were classified as overweight by BMI, and 3 students who were classified as standard weight by BMI were classified as overweight by OI. Secondly, by DEXA and BIA measurements, there was 1.51% difference in body fat percentage (boys 1.66%, girls 1.17%) and the difference in body fat mass between boys and girls was 0.77 kg (boys 0.85 kg, girls 0.59 kg), but those differences in body fat percentage and mass were not statistically significant. Thirdly, the average total abdominal fat (TAF) measured by CT scans of obese children was more significantly related with subcutaneous fat (r = 0.983, P < 0.01) than visceral fat (r = 0.640, P < 0.01). Also, TAF were highest significant with waist circumference by a tape measure (r = 0.744, P < 0.01). In summary, as there are some differences of assessment results between two obesity test methods (BMI, OI), we need more definite standards to determine the degree of obesity. The BIA seems to be the most simple and effective way to measure body fat mass, whereas waist/hip ratio (WHR) using a tape measurer is considered to be the most effective method for assessing abdominal fat in elementary students.

Associação entre ângulo de fase, PRISM I e gravidade da sepse / Association between phase angle, PRISM I and sepsis severity

JUSTIFICATIVA E OBJETIVOS: Ângulo de fase (AF) é a diferença entre a voltagem e a corrente e pode ser usado como indicador de massa celular corporal. Estudos clínicos mostram que baixos AF estão associados com morbidade e mortalidade em pacientes críticos. O objetivo deste estudo foi conhecer a relação entre AF e o escore pediátrico de risco de mortalidade (PRISM I) em pacientes pediátricos sépticos críticos, associando esse indicador c om a gravidade da sepse. MÉTODO: Estudo transversal realizado na Unidade de Terapia Intensiva (UTI) Pediátrica do Instituto Fernandes Figueira. Os pacientes foram caracterizados de acordo com faixa etária, sexo, gravidade da sepse, etiologia da insuficiência respiratória, escore de PRISM I, grau de disfunção de múltiplos órgãos e sistemas (DMOS). A análise de bioimpedância elétrica (BIA) foi realizada em todos os pacientes e, através da razão dos valores de reactância (Xc) e resistência (R), foi calculado o AF (AF = arco-tangente da reactância/resistência x 180º /Pi). RESULTADOS: Foram avaliados 75 pacientes, sendo 68 (90,7 por cento) com sepse. A incidência de choque séptico foi 39,7 por cento, sepse grave 42,6 por cento e sepse 17,6 por cento. Não houve diferença estatística significativa entre as médias de ângulo de fase e as categorias de PRISM I, porém observou-se uma relação inversa entre os valores de AF e as categorias de PRISM I, DMOS e tempo de internação. Os valores mais baixos de AF (1,5º-2,2º) foram observados no maior escore de PRISM I (> 30 por cento). CONCLUSÕES: Os pacientes pediátricos críticos apresentaram baixos valores de angulo de fase, portanto deve ter a sua importância prognóstica estudada.

BACKGROUND AND OBJECTIVES: Phase angle (PA) is the difference between voltage and current and can be used as an indicator of body cell mass. Clinical studies show that low phase angle is associated with morbidity and mortality of critical patients. The purpose of this study was to know the relation between phase angle and the Pediatric Risk of Mortality I (PRISM I) score, associating this score with the severity of sepsis. METHODS: A transversal study was performed at the Pediatric Intensive Care Unit (PICU) in Instituto Fernandes Figueira. The patients were classified according to age, gender, sepsis severity, cause of respiratory failure, PRISM I score, multiple organ dysfunction syndromes (MODS). Electrical bioimpedance analysis (BIA) was performed in all patients. Phase angle was calculated directly from reactance (Xc) and resistance (R). AF = arc-tangent reactance/resistance x 180º/Pi. RESULTS: 75 patients (68 septic) were evaluated. The incidence of septic shock was 39.7 percent, severe sepsis 42.6 percent and sepsis 17.6 percent. There was no significative statistical difference between the mean values of BIA and the categories of PRISM I, MODS, or the length of stay the PICU. The PA's lowest values (1.5º-2.2º) were associated to the greatest PRISM's scores (> 30 percent). CONCLUSIONS: Pediatric critical patients show low phase angle values, which might have prognostic implication.

RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND FLUID DISTRIBUTION IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS / 营养学报

Objective: To investigate the relationship between nutritional status and body fluid distribution in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Sixty-six CAPD patients without edema were recruited in this study. Patients’ fluid status was measured by bioimpedance analysis (BIA) and nutritional status was assessed by subjective global assessment (SGA). Thirty-six age-matched healthy people served as controls. Results: As compared to the healthy control, CAPD patients had significant abnormal fluid distribution in the body with significantly decreased intracellular water (ICW) and little change in extracellular water (ECW). Malnutrition further aggregated the changes in body fluid distribution. Conclusion: Body fluid distribution is abnormal in CAPD patients and may be affected by patients’ nutritional status. The ratio of ICW/ECW can not be correctly used to evaluate hydration state when the patient is malnourished. Key word: intracellular water (ICW); extracellular water (ECW); bioimpedance analysis (BIA); malnutrition