Impact of pathologic body composition assessed by CT-based anthropometric measurements in adult patients with multiple trauma: a retrospective analysis
In recent years, there has been mounting evidence on the clinical importance of body composition, particularly obesity and sarcopenia, in various patient populations. However, the relevance of these pathologic conditions remains controversial, especially in the field of traumatology. Computed tomography-based measurements allow clinicians to gain a prompt and thorough assessment of fat and muscle compartments in trauma patients. Our aim was to investigate whether CT-based anthropometric parameters of fat and muscle tissues show correlations with key elements of pre-hospital and clinical care in an adult population with multiple trauma.
In this retrospective analysis we searched our institutional records of the German Trauma Registry (TraumaRegister DGU®) from January 2008 to May 2014. Included were 297 adult trauma patients with multiple trauma who underwent a whole-body CT-scan on admission and were treated in an ICU. We measured anthropometric determinants of abdominal core muscle and adipose tissue using the digital imaging software OsiriX™. Multivariate linear and logistic regression analyses were conducted to unveil potential correlations.
None of the obesity-linked anthropometric parameters were associated with longer pre-hospital or initial ED treatment times. Obese patients were less frequently intubated at the site of the accident. Patients with increased abdominal fat tissue received on average lower volumes during fluid resuscitation in the pre-hospital phase but were not more often in shock on admission. During ED treatment, fluid resuscitation and transfusion volumes were not affected by abdominal fat tissue, although transfusion rates were higher in the obese. Furthermore, damage control surgeries took place less frequently in patients with increased abdominal fat tissue markers. Obesity parameters did not affect the prevalence of sepsis, although increased abdominal fat was associated with higher white blood cell counts on admission. Finally, there was no statistically significant correlation between sarcopenia or obesity markers and duration of mechanical ventilation, ICU length of stay or neurologic outcome.
CT-based assessment of abdominal fat and muscle mass is a simple method in revealing pathologic body composition in trauma patients. Our study suggests that obesity influences pre-hospital and ED treatment and early immune response in multiple trauma. Nevertheless, we could not demonstrate any significant effect of abdominal fat and muscle tissue parameters on the course of treatment, in particular the duration of mechanical ventilation, ICU length of stay and neurologic outcome.
KeywordsObesity Sarcopenia Multiple trauma Anthropometry
Abbreviated injury scale
Body mass index
Central nervous system
German Society for Trauma Surgery
Digital Imaging and Communications in Medicine
Glasgow Coma Scale
Glasgow Outcome Scale
Red blood cell
Sagittal abdominal diameter
Systolic blood pressure
- SAPS II
Simplified acute physiology score
Subcutaneous adipose tissue
Skeletal muscle index
Sequential organ failure assessment
Total muscle area
Visceral adipose tissue
White blood cell
The authors thank Anne Guo for comments that greatly improved the manuscript.
According to the definitions outlined by the International Committee of Medical Journal Editors (ICMJE), the authors listed above qualify for authorship based on having made one or more substantial contributions to the intellectual content of the article: BP, TW, TI designed the study. BP, TI, WB, PPa acquired the data. BP, PPr, AV analysed and interpreted the data. BP, TW drafted the manuscript. All authors approved the final submitted version of the manuscript.
Compliance with ethical standards
Conflict of interests
The authors declare that they have no competing interests.
The present study was approved by the local institutional review board (UE no. 71-15).
The requirement to obtain an informed consent form was waived.
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