Pinto LP, Marroni CA, Czermainski J, Dahlem MLF, Carteri RB, Fernandes SA. Role of the phase angle in the prognosis of the cirrhotic patient: 15 years of follow-up. World J Methodol 2023; 13(4): 238-247 [PMID: 37771877 DOI: 10.5662/wjm.v13.i4.238]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
The number of new cases of cirrhotic patients is growing worldwide and, as a consequence, an increase in the demand for specialized care to treat the disease per se and the complications inherent in cirrhosis, in addition to the increase in patients on the waiting list for orthotopic transplantation of liver. Given this scenario, it is necessary to identify a tool to predict the mortality of these patients linked to their clinical condition. Within this perspective, the phase angle (PA) becomes a good alternative because it is a viable method in clinical practice, with the potential to guide the clinical management of the patient and extend their survival time and better quality of life.
Research motivation
Identifying a tool capable of predicting mortality and severity of chronic liver disease in real time as a clinical practice brings numerous benefits to this population and to the professionals who treat them.
Research objectives
To the best of our knowledge, no study has evaluated the role of PA as a predictor of mortality in cirrhotic patients with a 15-year follow-up.
Research methods
Retrospective cohort study with 129 cirrhotic patients of both genders aged over 18 years. Diagnosis of cirrhosis by liver biopsy. 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. Mortality was assessed using the PA percentile using Kaplan-Meier curves and multivariate binary logistic regression models.
Research results
The percentile ranking was more accurate in identifying long-term deaths than the 5.4th 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), INR (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 a 1° increase in PA increases the chance of survival of cirrhotic patients by 17.7%.
Research conclusions
PA is a good predictor of morbidity and mortality for cirrhotic patients.
Research perspectives
Identifying clinical factors that enhance a poor prognosis for cirrhotic patients, such as ascites, encephalopathy, length of stay, is relevant. With this information, it is possible to act early in the clinical management of these patients and increase the effectiveness of the therapeutic response, with consequent improvement in the prognosis and quality of life of this population.
