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BIOIMPEDANCE VECTOR ANALYSIS (BIVA) PREDICTS MORBIDITY FOLLOWING PANCREATIC RESECTION FOR CANCER
Nutrition 65 (2019) 110580
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
SINPE conference abstracts BIOIMPEDANCE VECTOR ANALYSIS (BIVA) PREDICTS MORBIDITY FOLLOWING PANCREATIC RESECTION FOR CANCER M. Sandini *,1, M. Angrisani 1, C. Bassi 3, R. Caccialanza 2, G. Capretti 4, F. Casciani 4, M. Cereda 1, S. Famularo 1, A. Giani 1, L. Gianotti 1, S. Paiella 3, A. Zerbi 4 1 School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy 2 Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 3 Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy 4 Pancreatic Surgery, Istituto Clinico Humanitas, Milano, Italy Bioimpedance vector analysis (BIVA) is a reliable tool to assess body composition and hydration status. Perioperative sarcopenia, sarcopenic obesity and hyperhydration have been associated with adverse outcomes after pancreatic surgery. Aim of our study was to evaluate whether perioperative BIVA predicts the occurrence of surgery-related morbidity. We prospectively measured BIVA of patients undergoing pancreatic resection at 3 Italian institutions, prior to surgery and on postoperative day (POD) 1. Morbidity was graded per the Clavien-Dindo Classification (CDC), and the Comprehensive Complication Index (CCI). We analyzed 249 patients. Overall complication rate was 61% and 16.5% had a CDC3. The median CCI was 24 (IQR 0.0-24.2), and 24 patients (9.6%) had a CCI40 (severe complications). Preoperative extracellular water (ECW) was significantly higher in patients who experienced severe morbidity according to the CDC [19.4 L (17.5-22.0) vs. ECW 18.2 L (15.6-20.6), p=0.009 in complicated and uncomplicated, respectively]; ECW was significantly higher in case of either CCI40, or not [ECW 20.3 L (18.5-22.7) vs. 18.3 L (15.6-20.6), p=0.002, respectively]. Hydration status on POD1 was significantly different in patients who either experienced major complications or not [ECW 23.9 L (20.6-22.5) vs. 19.7 L (17.3-23.1), p=0.020 and hydration index HI 80.7% (75.3-85.3) vs. 73.9% (73.679.8), p<0.001, for CDC and ECW 24.8 L (20.3-26.7) vs. 19.8 L (17.5-23.5), p=0.025 and HI 80.4 L (77.1-87.2) vs. 74.0% (73.6-80.7), p=0.002, for CCI]. Perioperative hydration status significantly predicts major morbidity after pancreatic surgery. BIVA can be useful for evaluation and monitoring of the hydration status and could be considered in clinical practice.
QUADRICEPS FEMORIS MUSCLE THICKNESS BY ULTRASOUND IN ACUTE KIDNEY INJURY: VALIDATION BY COMPUTERIZED TOMOGRAPHY A. Sabatino *,1, G. Regolisti 1, F. Di Mario 1, A. Parmigiani 1, M.R. Vari 1, M.T. Farina 1, M. Gentile 1, A. Ciuni 2, A. Palumbo 2, E. Fiaccadori 1 1 di Parma, Parma, Italy Nefrologia Universita 2 Radiologia Azienda Ospedaliera Universitaria Parma, Parma, Italy Muscle wasting in the ICU is an early effect of acute illness. Ultrasound (US) is increasingly used to evaluate muscle thickness/mass in different clinical settings, and in patients with AKI it has been shown that is reliable, accurate and not influenced by fluid balance changes (1). The current study was aimed at https://doi.org/10.1016/j.nut.2019.110580 0899-9007/
validating this method on the quadriceps femoris muscle (QFM) by a gold standard imaging technique, computerized tomography (CT). Observational study approved by the local Ethical Committee in critically patients with stage 3 AKI consecutively admitted to the Renal ICU of Parma University Hospital. Quadriceps rectus femoris and vastus intermedius thickness were measured by US. CT scans were taken at the same exact sites. Written informed consent was obtained by the patients or their next of kin. Pairwise comparison between US and CT-scans measurements (30 patients, 233 measurements) revealed no differences between the two methods (1.21 [§0.45] versus 1.22 [§0.43], P = 0.38). Correlation coefficient was high for all sites, (0.85-0.95, P < 0.0001). A Bland-Altman plot (all measurements, n = 233) showed quite low bias values (-0.01, SD 0.18) and limits of agreement (- 0.35 to 0.33). Ultrasound is a valid technique to be applied at the bedside of critically ill patients with AKI for the assessment of quadriceps muscle thickness. 1. Sabatino A, Regolisti G, Delsante M et al. Reliability of bedside ultrasound for measurement of quadriceps muscle thickness in critically ill patients with acute kidney injury. Clin Nutr. 2017; 36: 1710-1715.
THE SLICE STUDY: THE PROGNOSTIC ROLE OF VISCERAL FAT IN METASTATIC COLORECTAL CANCER D. Basile *,2, M. Borghi 1, C. Lisanti 2, M. Bartoletti 2, L. Gerratana 2, L. Bortot 2, C. Corvaja 2, S.K. Garattini 2, G. Pelizzari 2, V. Fanotto 2, L. Da Ros 3, P. Di Nardo 3, E. Torrisi 3, M. Guardascione 4, C.A. Bertuzzi 1, F. Fabiani 1, G. Miolo 3, A. Buonadonna 3, F. Puglisi 2 1 Intensive Care Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy 2 Department of Medicine (DAME), University of Udine, IT; Department of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy 3 Department of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy 4 Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy Overweight is an established risk factor of the colorectal cancer initiation and progression. Aim of this study is to investigate the prognostic role of visceral fat (VAT) in metastatic colorectal cancer (MCRC). We retrospectively analyzed 71 consecutive MCRC patients (2013-2017) at the Oncology Department of CRO Aviano (Italy). VAT area was measured as of cross-sectional area (cm2) at the L3 level divided by the square of the height (m2). A ROC analysis was performed to define a threshold capable to identify distinct prognostic categories of patients according to VAT. Subsequently, the value of VAT in predicting overall survival (OS) was evaluated with uni- and multivariate Cox regression analyses and estimated with Kaplan-Meier curves. Patients’ characteristics before first-line chemotherapy are reported in table 1. Interestingly, 40 pts (56%) had a body mass index (BMI)>25 and 42 (59%) had median VAT of 51.94. LDH level>=480 UI/L was recorded in 12 patients (27%) reflecting the inflammatory response. The optimal cut-
Contents lists available at ScienceDirect
Nutrition journal homepage: www.nutritionjrnl.com
SINPE conference abstracts BIOIMPEDANCE VECTOR ANALYSIS (BIVA) PREDICTS MORBIDITY FOLLOWING PANCREATIC RESECTION FOR CANCER M. Sandini *,1, M. Angrisani 1, C. Bassi 3, R. Caccialanza 2, G. Capretti 4, F. Casciani 4, M. Cereda 1, S. Famularo 1, A. Giani 1, L. Gianotti 1, S. Paiella 3, A. Zerbi 4 1 School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy 2 Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy 3 Unit of General and Pancreatic Surgery, The Pancreas Institute, Policlinico GB Rossi, University of Verona Hospital Trust, Verona, Italy 4 Pancreatic Surgery, Istituto Clinico Humanitas, Milano, Italy Bioimpedance vector analysis (BIVA) is a reliable tool to assess body composition and hydration status. Perioperative sarcopenia, sarcopenic obesity and hyperhydration have been associated with adverse outcomes after pancreatic surgery. Aim of our study was to evaluate whether perioperative BIVA predicts the occurrence of surgery-related morbidity. We prospectively measured BIVA of patients undergoing pancreatic resection at 3 Italian institutions, prior to surgery and on postoperative day (POD) 1. Morbidity was graded per the Clavien-Dindo Classification (CDC), and the Comprehensive Complication Index (CCI). We analyzed 249 patients. Overall complication rate was 61% and 16.5% had a CDC3. The median CCI was 24 (IQR 0.0-24.2), and 24 patients (9.6%) had a CCI40 (severe complications). Preoperative extracellular water (ECW) was significantly higher in patients who experienced severe morbidity according to the CDC [19.4 L (17.5-22.0) vs. ECW 18.2 L (15.6-20.6), p=0.009 in complicated and uncomplicated, respectively]; ECW was significantly higher in case of either CCI40, or not [ECW 20.3 L (18.5-22.7) vs. 18.3 L (15.6-20.6), p=0.002, respectively]. Hydration status on POD1 was significantly different in patients who either experienced major complications or not [ECW 23.9 L (20.6-22.5) vs. 19.7 L (17.3-23.1), p=0.020 and hydration index HI 80.7% (75.3-85.3) vs. 73.9% (73.679.8), p<0.001, for CDC and ECW 24.8 L (20.3-26.7) vs. 19.8 L (17.5-23.5), p=0.025 and HI 80.4 L (77.1-87.2) vs. 74.0% (73.6-80.7), p=0.002, for CCI]. Perioperative hydration status significantly predicts major morbidity after pancreatic surgery. BIVA can be useful for evaluation and monitoring of the hydration status and could be considered in clinical practice.
QUADRICEPS FEMORIS MUSCLE THICKNESS BY ULTRASOUND IN ACUTE KIDNEY INJURY: VALIDATION BY COMPUTERIZED TOMOGRAPHY A. Sabatino *,1, G. Regolisti 1, F. Di Mario 1, A. Parmigiani 1, M.R. Vari 1, M.T. Farina 1, M. Gentile 1, A. Ciuni 2, A. Palumbo 2, E. Fiaccadori 1 1 di Parma, Parma, Italy Nefrologia Universita 2 Radiologia Azienda Ospedaliera Universitaria Parma, Parma, Italy Muscle wasting in the ICU is an early effect of acute illness. Ultrasound (US) is increasingly used to evaluate muscle thickness/mass in different clinical settings, and in patients with AKI it has been shown that is reliable, accurate and not influenced by fluid balance changes (1). The current study was aimed at https://doi.org/10.1016/j.nut.2019.110580 0899-9007/
validating this method on the quadriceps femoris muscle (QFM) by a gold standard imaging technique, computerized tomography (CT). Observational study approved by the local Ethical Committee in critically patients with stage 3 AKI consecutively admitted to the Renal ICU of Parma University Hospital. Quadriceps rectus femoris and vastus intermedius thickness were measured by US. CT scans were taken at the same exact sites. Written informed consent was obtained by the patients or their next of kin. Pairwise comparison between US and CT-scans measurements (30 patients, 233 measurements) revealed no differences between the two methods (1.21 [§0.45] versus 1.22 [§0.43], P = 0.38). Correlation coefficient was high for all sites, (0.85-0.95, P < 0.0001). A Bland-Altman plot (all measurements, n = 233) showed quite low bias values (-0.01, SD 0.18) and limits of agreement (- 0.35 to 0.33). Ultrasound is a valid technique to be applied at the bedside of critically ill patients with AKI for the assessment of quadriceps muscle thickness. 1. Sabatino A, Regolisti G, Delsante M et al. Reliability of bedside ultrasound for measurement of quadriceps muscle thickness in critically ill patients with acute kidney injury. Clin Nutr. 2017; 36: 1710-1715.
THE SLICE STUDY: THE PROGNOSTIC ROLE OF VISCERAL FAT IN METASTATIC COLORECTAL CANCER D. Basile *,2, M. Borghi 1, C. Lisanti 2, M. Bartoletti 2, L. Gerratana 2, L. Bortot 2, C. Corvaja 2, S.K. Garattini 2, G. Pelizzari 2, V. Fanotto 2, L. Da Ros 3, P. Di Nardo 3, E. Torrisi 3, M. Guardascione 4, C.A. Bertuzzi 1, F. Fabiani 1, G. Miolo 3, A. Buonadonna 3, F. Puglisi 2 1 Intensive Care Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy 2 Department of Medicine (DAME), University of Udine, IT; Department of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy 3 Department of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy 4 Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italia, Aviano, Italy Overweight is an established risk factor of the colorectal cancer initiation and progression. Aim of this study is to investigate the prognostic role of visceral fat (VAT) in metastatic colorectal cancer (MCRC). We retrospectively analyzed 71 consecutive MCRC patients (2013-2017) at the Oncology Department of CRO Aviano (Italy). VAT area was measured as of cross-sectional area (cm2) at the L3 level divided by the square of the height (m2). A ROC analysis was performed to define a threshold capable to identify distinct prognostic categories of patients according to VAT. Subsequently, the value of VAT in predicting overall survival (OS) was evaluated with uni- and multivariate Cox regression analyses and estimated with Kaplan-Meier curves. Patients’ characteristics before first-line chemotherapy are reported in table 1. Interestingly, 40 pts (56%) had a body mass index (BMI)>25 and 42 (59%) had median VAT of 51.94. LDH level>=480 UI/L was recorded in 12 patients (27%) reflecting the inflammatory response. The optimal cut-