86 CHAPTER 5 5.4 DISCUSSION In our study BIA-derived PhA was an independent predictor of one-year mortality after ICU-admission in a mixed population of medical and surgical, acute and elective ICU-patients. In several studies, a predictive value of PhA was reported after 28-90 days follow-up, but to our knowledge this is the first study with a follow up of 1-year.10-12 In our population, we confirmed 4.6° as an optimal cut-off value for PhA in relation to long-term mortality after ICU-admission. This was in line with previous observations by Stapel et al. (2018), with an optimal cut-off value of 4.8° in ICU-patients 90 days after ICU-admission. In many disease states, including cancer, renal failure, and chronic neurological diseases a lower PhA is associated with decreased survival.9 It is conceivable that in specific ICU-patient groups tailored cut-off values of PhA can be identified, as suggested in a study with COVID-19 patients, where a cut-off value 3.95 was found.11 To interpret the value of PhA at the time of ICU-admission some considerations should be made. BIA-derived PhA assigns a value to body composition, in which a lower value reflects less muscle tissue, more extracellular fluids and/or Figure 2. Kaplan Meier curve of 1-year survival of patients with low and higher PhA.
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