Predictive value of APACHE II score is improved by combination with bioelectrical impedance analysis in multiple trauma patients

Background

Indication to extensive critical care could be ameliorated by combining APACHE II (AP II) scores [1] with the Phase-Angle (PA, φ), a global parameter of nutritional status derived from Bioelectrical Impedance Analysis (BIA) [2].

Methods

40 (30 male/10 female) multiple trauma patents (age: 16-81 years) with a stay of >5 days on the Intensive Care Unit (ICU) were studied retrospectively. Routinely obtained daily measurements of nutritional status (BIA 101 Impedance Analyser, RJL-Systems) included calculations of PA.

Results

10/40 patients (25%) died during ICU stay (Table). In all patients with AP II scores ≥20 (APACHE II-Class ≥5) determination of outcome would have been correct by Phase-Angle: all deceased patients had a PA <3, while surviving patients had a PA >4 (P < 0.05). Discriminance analysis of this data reveals a probability of 100% for prediction of survival and 94% for lethal outcome respectively.

Conclusion

Even in this small sample of multiple trauma patients there is a clear cutoff level of PA >4 for prediction of survival. We suggest the routine use of BIA for observation of ICU patents, but further studies are needed to establish the prognostic relevance of this method.

Table