Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study

Robbert Cleymaet; Thomas Scheinok; Hanne Maes; Amber Stas; Luca Malbrain; Inneke De laet; Karen Schoonheydt; Hilde Dits; Niels van Regenmortel; Michaël Mekeirele; Andrea Minini; Paolo Severgnini; Adrian Wong; Manu L.N.G. Malbrain

doi:10.5114/ait.2021.103526

eISSN: 1731-2531
ISSN: 1642-5758

Anaesthesiology Intensive Therapy

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Original paper

Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study

Robbert Cleymaet

^{1, 2}

,

Thomas Jonathan Scheinok

¹

,

Hanne Maes

¹

,

Amber Stas

¹

,

Luca Malbrain

³

,

Inneke De laet

⁴

,

Karen Schoonheydt

⁴

,

Hilde Dits

⁴

,

Niels van Regenmortel

⁴

,

Michaël Mekeirele

¹

,

Andrea Minini

^{1, 5}

,

Paolo Severgnini

^{5, 6}

,

Adrian Wong

⁷

,

Manu L.N.G. Malbrain

^{4, 8, 9}

Department of Intensive Care Medicine, University Hospital Brussels (UZB), Jette, Belgium
Faculty of Medicine and Health Sciences, Universiteit Gent (UGent), Gent, Belgium
University School of Medicine, Katholieke Universiteit Leuven (KUL), Leuven, Belgium
Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, ZNA Stuivenberg, Antwerp, Belgium
School of Anaesthesia and Intensive Care, Dipartimento di Biotecnologie e Scienze della Vita, Insubria University, Varese, Italy
Department of Anestesia e Rianimazione Cardiologica, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi , Varese, Italy
Department of Intensive Care Medicine and Anaesthesia, King’s College Hospital, Denmark Hill, London, UK
Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium
International Fluid Academy, Lovenjoel, Belgium

Anaesthesiol Intensive Ther 2021; 53, 1: 10–17

DOI: https://doi.org/10.5114/ait.2021.103526

Online publish date: 2021/02/23

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AMA

Cleymaet R, Scheinok TJ, Maes H, et al. Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study. Anaesthesiology Intensive Therapy. 2021;53(1):10-17. doi:10.5114/ait.2021.103526.

APA

Cleymaet, R., Scheinok, T. J., Maes, H., Stas, A., Malbrain, L.,  & De laet, I. et al. (2021). Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study. Anaesthesiology Intensive Therapy, 53(1), 10-17. https://doi.org/10.5114/ait.2021.103526

Chicago

Cleymaet, Robbert, Thomas J Scheinok, Hanne Maes, Amber Stas, Luca Malbrain, Inneke De laet,  and Karen Schoonheydt et al. 2021. "Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study". Anaesthesiology Intensive Therapy 53 (1): 10-17. doi:10.5114/ait.2021.103526.

Harvard

Cleymaet, R., Scheinok, T., Maes, H., Stas, A., Malbrain, L., De laet, I., Schoonheydt, K., Dits, H., van Regenmortel, N., Mekeirele, M., Minini, A., Severgnini, P., Wong, A.,  and L.N.G. Malbrain, M. (2021). Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study. Anaesthesiology Intensive Therapy, 53(1), pp.10-17. https://doi.org/10.5114/ait.2021.103526

MLA

Cleymaet, Robbert et al. "Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study." Anaesthesiology Intensive Therapy, vol. 53, no. 1, 2021, pp. 10-17. doi:10.5114/ait.2021.103526.

Vancouver

Cleymaet R, Scheinok T, Maes H, Stas A, Malbrain L, De laet I et al. Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study. Anaesthesiology Intensive Therapy. 2021;53(1):10-17. doi:10.5114/ait.2021.103526.

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Introduction
The non-invasive analysis of body fluid composition with bio-electrical impedance analysis (BIA) provides additional information allowing for more personalised therapy to improve outcomes. The aim of this study is to assess the prognostic value of fluid overload (FO) in the first week of intensive care unit (ICU) stay.

Material and methods
A retrospective, observational analysis of 101 ICU patients. Whole-body BIA measurements were performed, and FO was defined as a 5% increase in volume excess from baseline body weight.

Results
Baseline demographic data, including severity scores, were similar in both the fluid overload-positive (FO+, n = 49) patients and in patients without fluid overload (FO–, n = 52). Patients with FO+ had significantly higher cumulative fluid balance during their ICU stay compared to those without FO (8.8 ± 7.0 vs. 5.5 ± 5.4 litres; P = 0.009), VE (9.9 ± 6.5 vs. 1.5 ± 1.5 litres; P < 0.001), total body water (63.0 ± 9.5 vs. 52.8 ± 8.1%; P < 0.001), and extracellular water (27.0 ± 7.3 vs. 19.6 ± 3.7 litres; P < 0.001). The presence of 5%, 7.5%, and 10% fluid overload was directly associated with increased ICU mortality rates. The percentage fluid overload (P = 0.039) was an independent predictor for hospital mortality.

Conclusions
A higher mortality rate in ICU-patients with FO was observed. FO is an independent prognostic factor because neither APACHE-II, SOFA, nor SAPS-II significantly differed on admission between survivors and non-survivors. Further research is needed to confirm these data prospectively and to evaluate whether BIA-guided deresuscitation in the subacute phase will improve mortality rates.

keywords:

Prognostic value of bioelectrical impedance analysis for assessment of fluid overload in ICU patients: a pilot study

Robbert Cleymaet 1, 2 , Thomas Jonathan Scheinok 1 , Hanne Maes 1 , Amber Stas 1 , Luca Malbrain 3 , Inneke De laet 4 , Karen Schoonheydt 4 , Hilde Dits 4 , Niels van Regenmortel 4 , Michaël Mekeirele 1 , Andrea Minini 1, 5 , Paolo Severgnini 5, 6 , Adrian Wong 7 , Manu L.N.G. Malbrain 4, 8, 9

fluids, overload, bio-electrical impedance analysis, BIA, volume excess, outcome, crtitically ill, total body water, extracellular water, lung water