Subcutaneous Adipose Tissue Radiation Attenuation Is Associated With Increased 1‐Year Mortality in Polytrauma Patients

Journal of Cachexia Sarcopenia and Muscle, vol. 16, pp. e13743

Abstract

BACKGROUND: Polytrauma patients with an Injury Severity Score (ISS) ≥ 16 have a high mortality rate. Early identification of patients at risk of mortality is key. Different risk stratification models are available; however, body composition on third lumbar computed tomography (L3 CT) is not routinely used. The aim of this study is to determine the effect of CT body composition on 1-year mortality in adult polytrauma patients. METHODS: Body composition analysis (L3 CT) was performed on 593 adult polytrauma patients. The associations with 1-year mortality were assessed using uni- and multivariable logistic regression analysis. As a sensitivity analysis, 1-year mortality was analysed using Kaplan-Meier survival curves, log-rank tests and Cox regression. RESULTS: (±4.07). Comorbidities were present in 327 (55.4%) patients, with an average Charlson Comorbidity Index (CCI) of 2.07 points (±2.1). The mean ISS score was 27.59 (±11.06); 323 (54.5%) patients had an ISS ≥ 25 points. Age, CCI, ISS, skeletal muscle index and skeletal muscle radiation attenuation (OR 1.053, 5.713, 3.711, 0. 563 and 0.533, respectively; p < 0.001), subcutaneous adipose tissue radiation attenuation (SATRA OR 1.253, p = 0.028) and visceral adipose tissue index (OR 1.242, p = 0.038) were significantly associated with 1-year mortality. In multivariable logistic regression, age, ISS and SATRA remained statistically significantly associated with 1-year mortality (OR 1.062, p < 0.001; OR 4.761, p < 0.001; OR 1.396, p = 0.009). CONCLUSIONS: This study demonstrated that subcutaneous adipose tissue radiation attenuation on emergency trauma CT scans is significantly associated with 1-year mortality in adult polytrauma patients. Additionally, we found a significant effect of age and ISS on 1-year mortality. Incorporating body composition analysis could lead to a better selection of patients at risk for 1-year mortality and aid in treatment decision-making.

Authors 10

1. Leanne L. G. C. Ackermans corresponding

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Medical Centre+ Maastricht The Netherlands

   Department of Traumatology Maastricht University Medical Centre+ Maastricht The Netherlands

2. Jasper C. Stokroos

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Traumatology Maastricht University Medical Centre+ Maastricht The Netherlands

3. David P.J. van Dijk

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Surgery Maastricht University Medical Centre+ Maastricht The Netherlands

4. Björn Winkens

   Maastricht University · Maastricht University Medical Centre · Care and Public Health Research Institute

   Affiliation as printed

   CAPHRI Care &amp; Public Health Research Institute Maastricht University Medical Centre+ Maastricht The Netherlands

   Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht

5. Martijn Poeze

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Traumatology Maastricht University Medical Centre+ Maastricht The Netherlands

6. Leonard Wee

   Maastricht University · Maastricht University Medical Centre · Maastro Clinic

   Affiliation as printed

   Clinical Data Science, Faculty of Health Medicine and Lifesciences Maastricht University Maastricht The Netherlands

   Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology Maastricht University Medical Centre+ Maastricht The Netherlands

7. Ralph Brecheisen

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Medical Centre+ Maastricht The Netherlands

8. Steven W.M. Olde Damink Aachen Department of General, Visceral and Transplantation Surgery

   RWTH Aachen University · Universitätsklinikum Aachen · Maastricht University Medical Centre

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery RWTH University Hospital Aachen Aachen Germany

   Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University Medical Centre+ Maastricht The Netherlands

9. Jan A. Ten Bosch

   Maastricht University Medical Centre

   Affiliation as printed

   Department of Traumatology Maastricht University Medical Centre+ Maastricht The Netherlands

10. Taco Johan Blokhuis

    Maastricht University Medical Centre

    Affiliation as printed

    Department of Traumatology Maastricht University Medical Centre+ Maastricht The Netherlands