Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Sep 20, 2023; 13(4): 238-247
Published online Sep 20, 2023. doi: 10.5662/wjm.v13.i4.238
Role of the phase angle in the prognosis of the cirrhotic patient: 15 years of follow-up
Letícia Pereira Pinto, Claudio Augusto Marroni, Juliana Czermainski, Maria Luiza Fernandes Dahlem, Randhall B Carteri, Sabrina Alves Fernandes
Letícia Pereira Pinto, Claudio Augusto Marroni, Juliana Czermainski, Sabrina Alves Fernandes, Department of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brazil
Maria Luiza Fernandes Dahlem, Department of Veterinary Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 91540-000, Brazil
Randhall B Carteri, Department of Nutrition, Centro Universitário Metodista IPA, Porto Alegre 90420-060, Brazil
Randhall B Carteri, Department of Nutrition, Centro Universitário Cesuca, Cachoerinha 94935-630, Brazil
Author contributions: Pinto LP contributed to the methodological development and material support, collected data, interpreted results, conducted data analysis, wrote and revised the manuscript; Marroni AC contributed to the conception and critical review of the manuscript; Czermainski J collected data and interpreted the results; Dahlem MLF contributed to the methodological development and material support; Carteri R conducted data analysis and interpreted the results; Fernandes SA designed the research project, collaborated in writing, and critically reviewed the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: This study was conducted in accordance with the Helsinki Declaration and was approved by the ethics and research committee of the Federal University of Health Sciences of Porto Alegre (UFCSPA), RS, Brazil, under the number 5203619. All participants signed the Informed Consent Form (TCLE) in advance.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There is no conflict of interest for any of the researchers.
Data sharing statement: No additional data is available for sharing.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sabrina Alves Fernandes, PhD, Research Scientist, Teacher, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Sarmento Leite 245, Porto Alegre 90050-170, Brazil. sabrinaafernandes@gmail.com
Received: July 2, 2023
Peer-review started: July 2, 2023
First decision: July 5, 2023
Revised: July 16, 2023
Accepted: July 25, 2023
Article in press: July 25, 2023
Published online: September 20, 2023
Processing time: 79 Days and 12.9 Hours
Abstract
BACKGROUND

In 2019, cirrhosis accounted for 2.4% of global deaths. The projection for 2030 is an increase in this index. In recent years, hospitalization costs have escalated by 36% for compensated cirrhosis and 24% for decompensated cirrhosis. Therefore, it is necessary to identify a tool capable of predicting the mortality of these patients according to their clinical condition and consequently extending their survival time. Different studies have shown that the phase angle (PA) can be a feasible method in clinical practice, with the potential to guide assertive patient management in the therapeutic of chronic liver disease.

AIM

To evaluate the prognostic role of PA in cirrhotic patients over a 15-year follow-up period.

METHODS

Retrospective cohort study with 129 cirrhotic patients of both sexes over 18 years old. Diagnosis of cirrhosis by liver biopsy. The first year of data collection was 2007, and data regarding outcomes was collected in 2023. Data were gathered from medical records, such as esophageal varices (EV), EV bleeding, ascites, spontaneous bacterial peritonitis (SBP), encephalopathy, laboratory findings and PA. The cut-off value for the PA was 5.4°, a value described in 2012 by Fernandes et al for 129 patients evaluated in this study and the cut-off points for the Brazilian population presented in percentiles (P), as described by Mattiello et al. The mortality was assessed using the PA percentile through Kaplan-Meier curves and multivariate binary logistic regression models.

RESULTS

Patients were divided into two groups according to the PA 5.4th (PA > 5.4°, n = 40; PA ≤ 5.4°, n = 89) PA percentile (< P50, n = 56; ≥ P50 n = 73). The percentile classification was more accurate in identifying long-term deaths than the 5.4º PA. Patients with < P50 had a higher number of relevant complications such as ascites, SBP, liver encephalopathy and HCC. PA is strongly correlated with serum albumin (P < 0.001), International Normalized Ratio (P = 0.01), total bilirubin (P = 0.02) and direct bilirubin (P = 0.003). PA is correlated with survival time (P < 0.001) and length of stay (P = 0.02). Logistic regression analysis shows that an increase of 1° in PA enlarges the cirrhotic patient's chance of survival by 17.7%.

CONCLUSION

PA is a good predictor of morbidity and mortality for cirrhotic patients. The PA by percentile showed greater sensitivity in predicting mortality compared to the cut-off point of 5.4º.

Keywords: Liver cirrhosis; Phase angle; Prognosis; Liver transplantation; Electrical bioimpedance

Core Tip: Cirrhosis is characterized by the destruction of hepatic cells, resulting in metabolic alterations that compromise the body's homeostasis. This has a detrimental effect on the patient's clinical condition, negatively impacting their prognosis. Identifying a parameter capable of predicting relevant events is essential for a more assertive approach, reducing mortality and promoting higher life quality. This study aimed to assess the prognostic role of Phase Angle (PA) in cirrhotic patients. One hundred and twenty-nine patients were included, concluding that PA is a promising tool in predicting the clinical condition of chronic liver disease.