Overhydration Assessed Using Bioelectrical Impedance Vector Analysis Adversely Affects 90-Day Clinical Outcome among SARS-CoV2 Patients: A New Approach

• Published in: Nutrients Vol. 14; no. 13; p. 2726
• Main Authors: Cornejo-Pareja, Isabel, Vegas-Aguilar, Isabel M, Lukaski, Henry, Talluri, Antonio, Bellido-Guerrero, Diego, Tinahones, Francisco J, García-Almeida, Jose Manuel
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30-06-2022; MDPI
• Subjects: Bioelectricity; Biomarkers; Body Composition; Body Water; Clinical outcomes; Coronaviruses; COVID-19; Creatinine; Disease transmission; Edema; Electric Impedance; extracellular water; Health services; Hospitals; Humans; Hydration; hydration fat-free mass; hydration status; Impedance; Infectious diseases; Laboratories; Medical prognosis; Mortality; Multivariate analysis; Patients; Prealbumin; Risk analysis; Risk factors; RNA, Viral; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Survival; survival and mortality analysis; total body water; Vector analysis; Water-Electrolyte Imbalance; Spain; COVID-19; hydration status; total body water; hydration fat-free mass; extracellular water; survival and mortality analysis
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu14132726

Background: COVID-19 has taken on pandemic proportions with growing interest in prognostic factors. Overhydration is a risk factor for mortality in several medical conditions with its role in COVID-19, assessed with bioelectrical impedance (BI), gaining research interest. COVID-19 affects hydration status. The aim was to determine the hydration predictive role on 90 d survival COVID-19 and to compare BI assessments with traditional measures of hydration. Methods: We studied 127 consecutive COVID-19 patients. Hydration status was estimated using a 50 kHz phase-sensitive BI and estimated, compared with clinical scores and laboratory markers to predict mortality. Results: Non-surviving COVID-19 patients had significantly higher hydration 85.2% (76.9−89.3) vs. 73.7% (73.2−82.1) and extracellular water/total body water (ECW/TBW) 0.67 (0.59−0.75) vs. 0.54 (0.48−0.61) (p = 0.001, respectively), compared to surviving. Patients in the highest hydration tertile had increased mortality (p = 0.012), Intensive Care Unit (ICU) admission (p = 0.027), COVID-19 SEIMC score (p = 0.003), and inflammation biomarkers [CRP/prealbumin (p = 0.011)]. Multivariate analysis revealed that hydration status was associated with increased mortality. HR was 2.967 (95%CI, 1.459−6.032, p < 0.001) for hydration and 2.528 (95%CI, 1.664−3.843, p < 0.001) for ECW/TBW, which were significantly greater than traditional measures: CRP/prealbumin 3.057(95%CI, 0.906−10.308, p = 0.072) or BUN/creatinine 1.861 (95%CI, 1.375−2.520, p < 0.001). Hydration > 76.15% or ECW/TBW > 0.58 were the cut-off values predicting COVID-19 mortality with 81.3% and 93.8% sensitivity and 64 and 67.6% specificity, respectively. Hydration status offers a sensitive and specific prognostic test at admission, compared to established poor prognosis parameters. Conclusions and Relevance: Overhydration, indicated as high hydration (>76.15%) and ECW/TBW (>0.58), were significant predictors of COVID-19 mortality. These findings suggest that hydration evaluation with 50 kHz phase-sensitive BI measurements should be routinely included in the clinical assessment of COVID-19 patients at hospital admission, to identify increased mortality risk patients and assist medical care.