1 Introduction
2 Methods
2.1 Methodology and protocol registration
2.2 Literature search
2.3 Literature inclusion and exclusion criteria
2.4 Study selection
2.5 Risk of bias assessment
2.6 Data analysis, processing and data synthesis
2.7 Statistical analysis
3 Clinical characteristics of bioelectrical phase angle
4 Results
4.1 Characteristics of the included studies
Variables | Moonen H.P. et al. [14] | Del Giorno R. et al. [43] | Cornejo-Pareja I. et al. [22] | Osuna-Padilla I.A. et al. [42] | Reyes-Torres C.A. et al. [41] | Moonen H.P. et al. [23] | Da Porto A. et al. [44] | Rosas-Carrasco O. et al. [40] |
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Country | Netherlands | Switzerland | Spain | Mexico | Mexico | Netherlands | Italy | Mexico |
Study Design | Observational Cross-sectional Study | Retrospective Observational Study | Prospective Observational Cohort Study | Prospective Observational Cohort Study | Prospective Observational Cohort Study | Prospective Observational Cohort Study | Prospective Observational Cohort Study | Prospective Observational Cohort Study |
Participants centres | One referral centre | One referral centre | One referral centre | One referral centre | Two referral centre | One referral centre | One referral centre | One referral centre |
Clinical profile | General ward and ICU patients | General ward patients | General ward and ICU patients | ICU patients | Post-extubated ICU patients | General ward and ICU patients | General ward patients | General ward patients |
Patients (n, age, sex) | n = 54 67y (IQR 64–71) 63% male | n = 90 64.5y (SD ± 13.7) 67.8% male | n = 127 69y (IQR 59–80) 59.1% male | n = 67 55.3y (SD ± 13.6) 76% male | n = 112 54y (SD ± 12,0) 82% male | n = 150 68y (IQR 66–70) 67% male | n = 150 69y (IQR 58–78) 68.7% male | n = 104 62,7y (SD ± 15,0) 51.9% male |
Outcomes and follow-up time | 28d-Disease severity: ICU admission + complications or mortality | LOS (> 21d), in-hospital mortality and ICU admission, Appetite-loss (until discharge) | 90d- Mortality | 60-d Mortality | Dysphagia post-extubation (until ICU discharge) | 90d-Disease severity: ICU admission + complications or mortality and LOS | 60-d IMV, In-hospital mortality | 20d- Mortality |
Event rate | Disease severity: 34/54 Mortality: 8/54, Complications: 28/54, ICU admission: 24/54 | LOS: 19/90, In-hospital mortality: 18/90, Appetite-loss: 28/90 | 16/127 | 25/67 | 46/112 | ICU: 41/150 Complications: 59/150 Disease severity: 77/150 | IMV: 23/150 Mortality: 22/150 | 42/104 |
Conclusion | A lower PhA increased the odds of morbidity, mortality and severe COVID-19 | PhA does not seem to add further predictive value | Low PhA < 3.95° is a significant independent predictor of mortality risk in COVID‐19 (sensitive 93.8% and specific 66.7%) | Low PhA value is a biological marker that could be a predictor of 60‐d mortality in COVID-19 critically ill PhA < 3.85° (♀) and < 5.25° (♂) could need special nutrition attention | Low PhA was associated with dysphagia in post-extubated patients. Lower PhA was an independent factor for swallowing recovery at discharge | PhA is independently correlated with an adverse outcome of COVID-19 | Malnutrition diagnosed by BIVA was associated with worse outcomes in COVID-19 patients. PhA was not significantly associated with need of IMV (only 0.7%) or mortality at 60 d | PhA was higher risk predictor of mortality than APACHE, SOFA, and CURB-65 at admission in patients hospitalized for COVID-19 |
Variables | Moonen H.P. et al. [14] | Del Giorno R. et al. [43] | Cornejo-Pareja I. et al. [22] | Osuna-Padilla I.A. et al. [42] | Reyes-Torres C.A. et al. [41] | Moonen H.P. et al. [23] | Da Porto A. et al. [44] | Rosas-Carrasco O. et al. [40] |
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Measurement methodology (BI-device and procedures) | InBody S10® (InBody Co., Ltd., Seoul, Korea) (PhA: 50 kHz) Variable: 2-11d | BIA 101, Akern Bioresearch®, Florence, Italy (50 kHz) The first 24 h after admission | BIA 101, Akern (Bioresearch®, Florence, Italy) (50 kHz) The first 72 h of admission | InBody S10® (InBody Co,Ltd, Seoul,Korea) (Frequency NA) Within 48 h of ICU admission and IMV | InBody S10® (InBody Co., Ltd., Seoul, Korea) (PhA: 50 kHz) At first 24 h of postextubation | InBody S10® (InBody Co., Ltd., Seoul, Korea) (PhA: 50 kHz) The first 24 h of admission | SECA® (model mBCA 525; Seca gmbh & Co, Hamburg, Germany) (Frequency NA) The first 36 h after admission | BIA Quantum V, RJL Systems (50 kHz) The first 24 h of admission |
Comparative groups | Ward vs. ICU patients | Normal vs. Nutritional risk patients | Survivors vs. Non-survivors | Survivors vs. Non-survivors | Non dysphagic vs. Dysphagic patients | Ward vs. ICU patients | Non-malnourished vs. Malnourished patients | Survivors vs. Non-survivors |
PhA (mean and reference values, RV) | 4.5º (4.2–4.8) RV: 5.6º-6.5º | 5.6º (± 1.14) RV: not available | 4.4º (3.2–5.4) RV: ♂:5.3–6.6º, ♀: 4.8-6º | 5.0º (SD ± 1.2) RV: Low SPhA < -1.65 | 4.8º (SD ± 1.1) RV: Low PhA < 4.8º | 5.4º (5.2–5.6) RV: 5.6º-6.5º | 5.5º (± 1.5) RV: not avalaible | 5.1º (± 1.6) RV: < 3.66º (-SD 1.65, p5) |
PhA comparative groups | 4.8º (4.4–5.2) vs. 4.1º (3.8–4.5), p = 0.017 | 5.7(± 4) vs. 5.4 (± 1.3), p = 0.386 | 4.5º (3.5–5.5) vs. 2.8º (2.08–3.68), p < 0.001 | 5.4º (± 1.2) vs. 4.4º (± 1.0), p < 0.001 | 5.2º (± 0.93) vs. 4.0º (± 0.96), p < 0.001 | 5.4º (5.2–5.7) vs. 5.2º (4.9–5.4), p = 0.14 | 5.9º (± 1.5) vs. 4.5º (± 0.7), p > 0.001 | 5.43º (± 1.5) vs. 4.8º (± 1.7), p = 0.0309 |
SPhA (mean, and RV) | Not available | Not available | -0.8 (-2.0 – 0.2) | -2.5 (-3.8 –-0.83) | Not available | Not available | Not available | Not available |
SPhA comparative groups | Not available | Not available | -0.7 (-1.8 –0.3) vs. -2.95 (-3.6 – -1.3), p < 0.001 | -3.7 (± 1.4) bs -2.0 (± 1.8), p = 0.002 | Not available | Not available | Not available | Not available |
Hydration status (mean and RV) | ECW/TBW: 0.40 (0.39–0.40) RV: 0.380 | TBW/FFM: Not available | TBW/FFM: 73.8% (73.3–84.3) RV: 72.7–74.3% | ECW/TBW 0.39 (± 0.01) RV: not available | ECW/TBW 0.395 (± 0.138) RV: if > 0.380 overhydration | ECW/TBW: 0.39 (0.39–0.39) RV: 0.36–0.39 | ECW/TBW: 0.451 (± 0.033) RV: not available | Not available |
Hydration comparative groups | 0.39 (0.39–0.40) vs. 0.40 (0.40–0.41), p = 0.015 | 74.3% (± 2.7) vs. 75.2% (± 3.2), p = 0.204 | 73.7% (73.2–82.1) vs. 85.2% (76.9–89.3), p < 0.001 | 0.386 (± 0.01) vs. 0.398 (± 0.01), p = 0.001 | 0.389 (± 0.010) vs. 0.402 (± 0.014), p < 0.001 | 0.39 (0.39–0.39) vs. 0.39 (0.39–0.39), p = 0.014* | 0.444 (± 0.032) vs. 0.47 (± 0.027), p < 0.001 | Not available |
Cellular mass (mean and RV) | SMI: 8.0 kg/m2 (7.6–8.4) FFM: 59.2 kg (55.4–63.1) SLM: 55.9 kg (52.3–59.5) | FFM: 58.2 kg (± 10.7) FFM index: 34.3 kg/m (± 6.0) BCM: 17.8 kg/m (± 4.7) | BCM: 21.4 kg (16.3–27.9) | Not available | Not available | SMI: 8.1 kg/m2 (7.8–8.3) BCM: 37.7 kg (36.2–39.2) FFM: 58.5 kg (56.3–60.7) SML: 55.1 kg (53.1–57.2) | FFM index 59.1 kg/m2 (± 13.3) SMM index: 27.1 kg/m2 (± 8.4) | AMM index: 7.44 kg/m2 (± 1.51) |
Cellular mass comparative groups | SMI: 7.5 (7.1–8.0) vs. 8.6 (7.9–9.2), p = 0.006 FFM: 55.5 (50.7–60.3) vs. 63.9 (57.8–70.0), p = 0.028 SLM: 52.4 (47.9–56.9) vs. 60.3 (54.6–66.1), p = 0.028 | FFM: 12.4 (± 5.3) vs. 12.5 (± 5.93), p = 0.921 FFM index: 33.9 (± 4.9) vs. 35.8 (± 9.4), p = 0.253 BCM: 17.6 (± 3.9) vs. 18.9 (± 6.9), p = 0.297 | BCM: 23 (18.5–31.5) vs. 14.2 (10.2–18.0), p < 0.001 | Not available | Not available | SMI: 7.9 (7.7–8.2) vs. 8.4 (8.1–8.8), p = 0.028 BCM: 36.8 (35.2–38.6) vs. 40.0 (37.8–42.0), p = 0.026 FFM: 57.2 (54.8–60.0) vs. 61.8 (58.6–65.0), p = 0.026 SML: 53.9 (51.7–56.4) vs. 58.3 (55.3–61.3), p = 0.024 | FFM index: 62.1 (± 13.1) vs. 49.9 (± 9.3), p < 0.001 SMM index: 29.1 (± 8.2) vs. 20.9 (± 5.7), p < 0.001 | AMMI: 7.25 (± 0.92) vs. 6.03 (± 1.29), p = 0.0148 |
R | Not available | Not available | R/H 302.5 Ω/m (272.2–366.3) | Not available | Not available | Not available | Not available | Not available |
Resistance comparative groups | Not available | Not available | 301.7 (272.2–363.5) vs. 334.6 (251.5–370.3), p = 0.769 | Not available | Not available | Not available | Not available | Not available |
Reactance | Not available | Not available | 24.7 Ω/m (16.3–31.1) | Not available | Not available | Not available | Not available | Not available |
Reactance comparative groups | Not available | Not available | 25.3 (18.9–32.4) vs. 15.0 (10.5–22.6), p = 0.001 | Not available | Not available | Not available | Not available | Not available |
4.2 Findings
4.3 Poor outcomes researched in admission patients with COVID-19
4.4 Quality of studies
№ of studies | Certainty assessment | Effect | Certainty | Importance | |||||||
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Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | № of events | № of individuals | Rate (95% CI) | |||
All-cause mortality in patients (ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 28 days; assessed with: phase angle) | |||||||||||
1 Moonen 2020 | observational studies | seriousa | not serious | not serious | seriousb | None | 8 | 54 | event rate 0.2 (-- to --) | ⨁⨁◯◯ Low | CRITICAL |
All-cause mortality in patients ( ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 90 days; assessed with: phase angle) | |||||||||||
1 Cornejo-Pareja 2021 | observational studies | not serious | not serious | not serious | seriousc | None | 16 | 127 | event rate 3.9 (1.322 to 11.572) | ⨁⨁⨁◯ Moderate | CRITICAL |
All-cause mortality in patients (ICU hospitalized SARS-CoV2 infection patients) (follow-up: 60 days; assessed with: phase angle (Low SPhA < -1.65) | |||||||||||
1 Osuna-Padilla 2021 | observational studies | not serious | not serious | seriousd | not serious | None | 25 | 67 | event rate 3.1 (1.12 to 8.41) | ⨁⨁⨁◯ Moderate | CRITICAL |
All-cause mortality in patients (General ward hospitalized SARS-CoV2 infection patients) (follow-up: 60 days; assessed with: phase angle) | |||||||||||
1 Da Porto 2021 | observational studies | not serious | not serious | seriouse | seriousf | None | 22 | 150 | event rate 1.1 (0.803 to 1.463) | ⨁⨁◯◯ Low | CRITICAL |
All-cause mortality in patients (General ward hospitalized SARS-CoV2 infection patients) (follow-up: 20 days, assessed with: phase angle < 3.66º) | |||||||||||
1 Rosas-Carrasco 2022 | observational studies | seriousg | not serious | not serious | not serious | None | 42 | 104 | event rate 2.6 (1.217 to 5.430) | ⨁⨁⨁◯ Moderate | CRITICAL |
Prolonged length hospital stay (defined as length hospital stay > 21 days) in patients (General ward hospitalized SARS-CoV2 infection patients) (assessed with: phase angle) | |||||||||||
1 Del Giorno 2020 | observational studies | serioush | seriousi | not serious | seriousj | None | 19 | 90 | event rate 1.0 (0.12 to 8.63) | ⨁◯◯ Very Low | IMPORTANT |
Length of hospital stay in patients (General ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 90 days; assessed with: phase angle) | |||||||||||
1 Moonen 2021 | observational studies | not serious | not serious | not serious | seriouk | None | – | 150 | event rate 0.9 (0.765 to 1.001) | ⨁⨁◯◯ Low | IMPORTANT |
Severity disease (evaluated by a composite score that comprised ICU admission and complications including mortality) in patients (General ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 28 days; assessed with: phase angle) | |||||||||||
1 Moonen 2020 | observational studies | seriousa | not serious | not serious | seriousbl | None | 34 | 54 | event rate 0.3 (-- to --) | ⨁⨁◯◯ Low | CRITICAL |
Severity disease (evaluated by a composite score that comprised ICU admission and complications including mortality) in patients (General ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 90 days; assessed with: phase angle) | |||||||||||
1 Moonen 2021 | observational studies | not serious | not serious | not serious | seriousc | None | 77 | 150 | event rate 0.5 (0.281 to 0.898) | ⨁⨁⨁◯ Moderate | CRITICAL |
Severe Disease (defined as Need for supportive care) with intensive mechanical ventilation in patients (General ward hospitalized SARS-CoV2 infection patients) (follow-up: 60 days; assessed with: phase angle) | |||||||||||
1 Da Porto 2021 | observational studies | not serious | not serious | seriouse | seriousf | None | 23 | 150 | event rate 1.0 (0.714 to 1.422) | ⨁⨁◯◯ Low | IMPORTANT |
Severity disease (evaluated by composite score that comprised in-hospital mortality and needs ICU admission) in patients (General ward hospitalized SARS-CoV2 infection patients) (assessed with: phase angle) | |||||||||||
1 Del Giorno 2020 | observational studies | serioush | seriousm | not serious | seriousn | None | 18 | 90 | event rate 0.6 (0.21 to 1.71) | ⨁◯◯◯ Very Low | CRITICAL |
COVID-19 complications (defined as thrombo-embolic event, renal failure, delirium, among others) in patients (General ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 28 days; assessed with: phase angle) | |||||||||||
1 Moonen 2020 | observational studies | seriousa | not serious | not serious | seriousb | None | 28 | 54 | event rate 0.4 (-- to --) | ⨁⨁◯◯ Low | IMPORTANT |
COVID-19 complications, (defined as thrombo-embolic event, renal failure, delirium, lung fibrosis, among others) in patients (General ward and ICU hospitalized SARS-CoV2 infection patients) (follow-up: 90 days; assessed with: phase angle) | |||||||||||
1 Moonen 2021 | observational studies | not serious | not serious | not serious | seriousc | None | 59 | 150 | event rate 0.6 (0.344 to 0.973) | ⨁⨁⨁◯ Moderate | IMPORTANT |
COVID-19 complications (defined as dysphagia post-extubation) in patients (ICU hospitalized SARS-CoV2 infection patients) (assessed with: phase angle < 4.8º) | |||||||||||
1 Reyes-Torres 2021 | observational studies | not serious | not serious | not serious | seriousc | None | 46 | 112 | event rate 12.2 (4.3 to 34.1) | ⨁⨁⨁◯ Moderate | IMPORTANT |
No. | Topic | Strength of recommendation | Quality of evidence | Recommendation |
---|---|---|---|---|
R1 | Phase angle | Strong | Moderate | The phase angle, measured by bioelectrical impedance analysis, can be used for predicting mortality in hospitalized patients with SARS-CoV2 |
R2 | Phase angle | Weak | Very Low-Low | The phase angle, measured by bioelectrical impedance analysis, can be suggest a longer length of hospital stay in hospitalized patients with SARS-CoV2 |
R3 | Phase angle | Weak | Very Low-Low | The phase angle, measured by bioelectrical impedance analysis, can advise severe disease in hospitalized patients with SARS-CoV2 |
R4 | Phase angle | Strong | Low–Moderate | The phase angle, measured by bioelectrical impedance analysis, can be used for predicting complications in hospitalized patients with SARS-CoV2 infection |