Bioelectrical impedance analysis-derived phase angle predicts osteosarcopenia and mortality in patients with chronic liver disease.

Osteosarcopenia, the coexistence of osteoporosis and sarcopenia, is linked to adverse clinical outcomes, emphasizing the need for routine assessment of this comorbidity. Phase angle (PhA), measured by bioelectrical impedance analysis (BIA), reflects cellular health (vitality and integrity) and nutritional status. This study investigated the relationship between PhA and osteosarcopenia or mortality and its predictive potential for both clinical events in patients with chronic liver disease (CLD). A retrospective study included 316 patients with CLD, 161 with cirrhosis. PhA was measured using direct segmental multi-frequency BIA. Osteoporosis and sarcopenia were diagnosed according to the World Health Organization and Japan Society of Hepatology criteria, respectively. Osteosarcopenia was present in 57 patients (18.0%). Over a median follow-up of 63.3 months, 47 liver-related deaths (29.2%) occurred among cirrhotic patients. Multivariate analysis identified low PhA as an independent risk factor for osteosarcopenia (odds ratio, 0.147; p < 0.001). The optimal PhA cutoff for predicting osteosarcopenia was 4.3° (sensitivity/specificity, 0.737/0.811). In patients with cirrhosis, survival rates were significantly lower in those with PhA < 4.3° compared to PhA ≥ 4.3° (p < 0.001). Multivariate analysis identified PhA < 4.3° as an independent predictor of mortality (hazard ratio, 2.588; p = 0.008). PhA, derived from BIA, was strongly associated with osteosarcopenia and mortality, making it a valuable indicator for simultaneously predicting these adverse outcomes in patients with CLD.