Correlation Of Phase Angle With Combined Sarcopenia And Frailty In Patients With Chronic Obstructive Pulmonary Disease

Background:Chronic obstructive pulmonary disease(COPD)is a common chronic respiratory disease.In addition to damaging the respiratory system,COPD can also have adverse effects on several systems of the body,and is gradually being regarded as a systemic disease with lung disease as its main focus.The identification and treatment of comorbidities have become an important part of the comprehensive management of COPD patients.Among them,sarcopenia and frailty are common physical-related comorbidities in COPD patients,mainly associated with chronic hypoxia,multiple medications,disease wasting,poor nutrition,lack of exercise and advanced age,leading to increased vulnerability to adverse health events in COPD patients.Current methods for identifying patients with COPD who have combined sarcopenia and debilitation are cumbersome,complex,and subjective,making them difficult to generalize in clinical practice.Phase angle(PhA)is a variable directly measured by bioelectrical impedance analysis(BIA)and is an indicator of cell number,cell membrane integrity,and cell function.It has been shown to be a useful indicator of muscle function and debilitation in the community in the elderly,cirrhosis,dialysis,and cancer populations,but research in COPD patients is limited.In this study,we measured PhA in COPD patients by BIA to investigate the correlation and predictive value of PhA with comorbid sarcopenia and frailty in COPD patients.Objective:To clarify the correlation between PhA and muscle mass and strength and somatic functional status in COPD patients,to find more convenient and reliable clinical indicators for predicting and diagnosing comorbid sarcopenia and frailty in COPD patients,and to provide theoretical guidance for healthcare workers to assess the physical status of COPD patients more rapidly and comprehensively.Method:COPD patients admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Henan University between December 2021 and December 2022(n=180)were XII retrospectively analyzed.The collected data included basic information: age,sex,height,weight,Body mass index(BMI),inflammatory indicators: C-reactive protein(CRP),Procalcitonin(PCT),nutritional indicators: Serum albumin(ALB),Prealbumin(PALB),and Forced expiratory volume in 1 second percentage of predicted(FEV1%pred),grip strength,6 m walking speed.The In Body S10 was used to quantify patients’ PhA,skeletal muscle mass index(SMI),muscle mass,and actual skeletal muscle.Basic information,lab measurements of lung function,grip strength,and 6-meter walking speed were gathered.Based on the diagnostic criteria recommended by the Asian Working Group for Sarcopenia(AWGS),patients were divided into two groups: those who did not have sarcopenia and those who did.Additionally,according to the Clinical Frailty Scale(CFS),patients were divided into non-frailty group and frailty group.Firstly,the prevalence of COPD patients with sarcopenia and frailty was analyzed.Secondly,the comparison between the sarcopenia group and the non-sarcopenia group,and the frailty group and the non-frailty group was conducted to analyze the differences between the groups in basic and other data.After that,Analysis was done on the relationship between PhA and the evaluation of muscle health state and other parameters.To investigate the relationship between PhA and the risk of developing sarcopenia and frailty disease,multivariate logistic regression analysis was utilized.To determine the connection between PhA and the degree of sarcopenia,a trend test was used.Finally,The predictive value of PhA in sarcopenia and frailty was calculated using the Receiver Operating Characteristic Curve(ROC)method.Results:1.A total of 180 COPD patients were included in this study,the prevalence of sarcopenia was 38.9%(n=70)and the prevalence of frailty was 34.4%(n=62).2.Between the non-sarcopenic group and the sarcopenic group,there were statistically significant differences in age,body weight,BMI,and classification of lung function(P<0.05),but not in gender or height.With statistical significance(P<0.05),the sarcopenia group’s FEV1%pred,6 m walking speed,grip strength,SMI,muscle mass,actual skeletal muscle,albumin,and prealbumin were all lower than those of the non-sarcopenia group.However,the sarcopenia group’s CRP and PCT were greater.The PhA in the sarcopenia group was 3.67±0.69° and in the non-sarcopenia group it was 4.81±1.04°,with a statistically significant difference(P<0.001).3.Between the non-frailty group and the frailty group,there were statistically significant differences in age,body weight,BMI,and classification of lung function(P<0.05),but not in gender or height.With statistical significance(P<0.05),the frailty group’s FEV1%pred,6 m walking speed,grip strength,SMI,muscle mass,actual skeletal muscle,albumin,and prealbumin were all lower than those of the non-frailty group.However,the frailty group’s CRP and PCT were greater.The PhA in the frailty group was 3.5(3.1,4.0)° and in the non-frailty group it was(4.1,5.3)°,with a statistically significant difference(P<0.001).4.PhA was positively correlated with body weight,BMI,FEV1%pred,muscle mass,actual skeletal muscle,ALB and PALB(P<0.05),and negatively correlated with age,CRP and PCT(P<0.05).5.PhA was positively correlated with SMI(r=0.698,P<0.001),grip strength(r=0.711,P<0.001),and6-meter walking speed(r=0.651,P<0.001),with statistical significance.6.PhA was negatively correlated with frailty scores using the CFS scale(r=-0.734,P<0.001),which was statistically significant.7.Multifactorial logistic regression analysis showed that PhA was independently associated with sarcopenia,low SMI,low grip strength,low 6 m walking speed,and frailty,and as PhA increased,the occurrence of sarcopenia(OR=0.371,95% CI=0.198～0.696,P=0.002),low SMI(OR=0.491,95% CI=0.279-0.864,P=0.014),low grip strength(OR=0.444,95% CI=0.257-0.768,P=0.004),low 6 m walking speed(OR=0.331,95% CI=0.191-0.576,P<0.001),and frailty(OR=0.206,95% CI=0.098～ 0.432,P<0.001)were all at reduced risk.8.The PhA of patients in the non-sarcopenia,pre-sarcopenia,sarcopenia,and severe sarcopenia groups were 4.75(4.10,5.60)°,4.50(3.93,4.88)°,4.10(3.50,4.55)°,and 3.40(2.85,3.75)°,respectively,with differences in the overall distribution of PhA in the four groups(J=-8.183,P<0.001).The differences between the non-sarcopenia,sarcopenia,and severe sarcopenia groups were statistically significant(P<0.05),but the differences between the pre-sarcopenia and non-sarcopenia and sarcopenia groups were not statistically significant(P>0.05).9.According to the ROC curve results,the critical value of PhA for predicting combined sarcopenia in COPD patients was 4.25°,with a specificity and sensitivity of 66.4% and 82.9%,respectively,and an area under the curve of 0.825(95%CI:0.765～0.886,P<0.001).The critical value of PhA for predicting combined frailty in COPD patients was 4.15°,with a specificity and sensitivity of 73.7% and 83.9%,respectively,and an area under the curve of 0.866(95%CI:0.812～0.919,P<0.001).Conclusions:1.The prevalence of sarcopenia and frailty is high in COPD inpatients,and COPD patients with combined sarcopenia and frailty have poorer physical function,poorer lung function,poorer nutritional status,and more severe infections.2.PhA has a good correlation with the assessment of muscle mass and strength,somatic function indicators,is closely related to the risk of comorbid sarcopenia and frailty in COPD patients,and has some predictive value for early comorbid sarcopenia and frailty,and maybe a good indicator to assist in the diagnosis of comorbid sarcopenia and frailty in COPD patients.