Association of CT-derived adipose measurements with prolonged intensive care unit stay in moderate and severe trauma patients.
Authors
Affiliations (7)
Affiliations (7)
- Department of diagnostic and interventional Radiology, Medical Center - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany. Electronic address: [email protected].
- Department of Orthopedics and Trauma Surgery, Medical Centre - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany.
- Department of diagnostic and interventional Radiology, Medical Center - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany.
- Department of Neuroradiology, Medical Center - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany.
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany.
- Department of Anesthesiology and Critical Care, Medical Centre - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany.
- Department of Orthopedics and Trauma Surgery, Medical Centre - Albert‑Ludwig's University Freiburg, Faculty of Medicine, Albert‑Ludwig's University of Freiburg, Germany; Department of Orthopedic Surgery, University Hospital Odense, Odense, Denmark.
Abstract
Obesity as measured by body mass index (BMI) has been associated with worse clinical outcomes in moderate and severe trauma patients. However, while BMI does not differentiate between different fat compartments, routine CT-derived body composition provides detailed assessment and may thus provide more accurate risk assessment. 200 eligible patients with moderate or severe trauma (injury severity score (ISS)≥ 9 from a level-1 trauma center were retrospectively identified and assembled into a 1:1 matched cohort (obese, BMI ≥ 30 kg/m vs. non-obese, BMI < 30 kg/m²), with exact matching on sex and close balancing on age and ISS. Patients with low quality CT imaging (n = 10), without intensive care unit (ICU) stay (n = 27) and death while hospital stay (n = 21) were excluded. CT-derived body composition measures including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), their respective indices (VATI, SATI) and a combined abdominal fat tissue index (AATI) were assessed from a single axial slice at the L3 vertebral level using a previously developed and validated deep learning segmentation model. A total of 142 ICU survivors formed the final study cohort (median age: 56 years (IQR 47-65), 16% female, 52% obese). VATI (ρ = 0.25 and 0.27, p = 0.003 and 0.001) and SATI (ρ = 0.19 and 0.24, p = 0.024 and 0.003) were significantly correlated with ICU length of stay (LOS) and ventilation duration, while BMI did not show a significant correlation. In a combined model with the BMI, AATI remained significant while BMI did not (+15.5% per SD; 95% CI 2.7-29.9%; p = 0.016 for ICU LOS; +30.8% per SD; 95% CI 12.4-52.3%; p < 0.001 for ventilation duration). CT-derived abdominal adiposity measurements from routine scans were more strongly and consistently associated with ICU LOS and ventilation duration than BMI. Thus, CT-based body composition analysis may improve individual risk assessment and management on ICU patients.