Clinical nutrition (Edinburgh, Scotland) · 2025
Prognostic impact of segmental extracellular water to total body water ratio in cardiovascular surgery patients.
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Shibata Kenichi, Adachi Takuji, Kameshima Masataka, Kito Hisako, Tanaka Chikako, Sano Taisei, Tanaka Mizuki, Ida Masayuki, Jinno Haruna, Kitamura Hideki
Аннотация
BACKGROUND AND AIMS: Perioperative fluid management is a key component of care for patients undergoing cardiovascular surgery. The ratio of extracellular water to total body water (ECW/TBW) has been recognized as a valuable biomarker for perioperative assessment, as it integrates information regarding fluid retention, muscle wasting, and nutritional status. However, evidence regarding the clinical utility of ECW/TBW and its association with long-term postoperative outcomes in cardiovascular surgery remains limited. This study aimed to investigate the prognostic value of ECW/TBW for long-term mortality in patients undergoing cardiovascular surgery.
METHODS: This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. ECW/TBW was assessed using bioelectrical impedance analysis before surgery and measured for the whole body, as well as each segment of the extremities. The association between ECW/TBW and all-cause mortality after discharge was assessed using Kaplan-Meier and multivariate Cox regression analyses. The cut-off value for all-cause mortality at each segmental ECW/TBW was calculated using the receiver operating characteristic curve.
RESULTS: In total, 859 patients were included in this study (mean age = 68.4 ± 11.9 years, 67.6 % male). Whole-body ECW/TBW showed a significant positive correlation with log NT-proBNP (ρ = 0.51, p < 0.001) and age (ρ = 0.58, p < 0.001) and negative correlation with skeletal muscle mass index (ρ = -0.33, p < 0.001), body mass index (ρ = -0.22, p < 0.001), peak grip strength (ρ = -0.60, p < 0.001), knee extension isometric muscle strength (ρ = -0.51, p < 0.001), and Geriatric Nutritional Risk Index (ρ = -0.51, p < 0.001). The mean follow-up period was 907.6 ± 500.8 days, during which 46 patients (5.4 %) died. Kaplan-Meier survival curves based on ECW/TBW tertiles showed that higher ECW/TBW was associated with worse prognosis (log-rank test, p < 0.001). Cox regression analysis showed an independent association between ECW/TBW and mortality risk, even after adjusting for multiple confounding factors. The cut-off values for all-cause mortality, derived from the receiver operating characteristic curve, were 0.396 (area under the curve [AUC], 0.768) for whole-body ECW/TBW, 0.390 (AUC, 0.764) for upper-extremity ECW/TBW, and 0.398 (AUC, 0.764) for lower-extremity ECW/TBW.
CONCLUSIONS: The segmental ECW/TBW is a useful predictor of long-term mortality in patients undergoing cardiovascular surgery. Although ECW/TBW strongly correlates with muscle mass and physical function, this correlation weakens at higher ECW/TBW levels, affecting measurement accuracy. Therefore, combining these measures may achieve more accurate postoperative risk stratification.
METHODS: This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. ECW/TBW was assessed using bioelectrical impedance analysis before surgery and measured for the whole body, as well as each segment of the extremities. The association between ECW/TBW and all-cause mortality after discharge was assessed using Kaplan-Meier and multivariate Cox regression analyses. The cut-off value for all-cause mortality at each segmental ECW/TBW was calculated using the receiver operating characteristic curve.
RESULTS: In total, 859 patients were included in this study (mean age = 68.4 ± 11.9 years, 67.6 % male). Whole-body ECW/TBW showed a significant positive correlation with log NT-proBNP (ρ = 0.51, p < 0.001) and age (ρ = 0.58, p < 0.001) and negative correlation with skeletal muscle mass index (ρ = -0.33, p < 0.001), body mass index (ρ = -0.22, p < 0.001), peak grip strength (ρ = -0.60, p < 0.001), knee extension isometric muscle strength (ρ = -0.51, p < 0.001), and Geriatric Nutritional Risk Index (ρ = -0.51, p < 0.001). The mean follow-up period was 907.6 ± 500.8 days, during which 46 patients (5.4 %) died. Kaplan-Meier survival curves based on ECW/TBW tertiles showed that higher ECW/TBW was associated with worse prognosis (log-rank test, p < 0.001). Cox regression analysis showed an independent association between ECW/TBW and mortality risk, even after adjusting for multiple confounding factors. The cut-off values for all-cause mortality, derived from the receiver operating characteristic curve, were 0.396 (area under the curve [AUC], 0.768) for whole-body ECW/TBW, 0.390 (AUC, 0.764) for upper-extremity ECW/TBW, and 0.398 (AUC, 0.764) for lower-extremity ECW/TBW.
CONCLUSIONS: The segmental ECW/TBW is a useful predictor of long-term mortality in patients undergoing cardiovascular surgery. Although ECW/TBW strongly correlates with muscle mass and physical function, this correlation weakens at higher ECW/TBW levels, affecting measurement accuracy. Therefore, combining these measures may achieve more accurate postoperative risk stratification.