5/21/2023 0 Comments Radiologik dj alternative![]() Nowadays, numerous more accurate methods are described to assess fat mass, such as bioelectrical impedance analysis, dual-energy X-ray, magnetic resonance imaging, and CT. As BMI is calculated using height and weight only, while not explicitly distinguishing between adipose tissue (compartment) and muscle mass, it could be a deceptive method to define obesity. However, in these studies, obesity was defined by calculating the body mass index (BMI). Previous research focusing on the effects of obesity in trauma populations showed that obesity was associated with adverse in-hospital outcomes. Obesity is a metabolic disorder associated with cardiovascular disease and an increased morbidity and mortality rate. The effect of sarcopenia on complications in oncological populations has been investigated thoroughly, while only a few studies on this topic were performed in trauma populations. Several studies showed that a low psoas muscle density, as measured using the mean radiation attenuation in Hounsfield Units (HU) possibly as a marker of lower muscle quality and fatty degeneration, may also be a risk factor for poor outcomes in trauma patients. Sarcopenia, based on a low psoas muscle area, was associated with the in-hospital, 30-day, and 1-year mortality in trauma patients. Sarcopenia, defined as a progressive and generalized skeletal muscle disorder associated with an increased likelihood of adverse outcomes, is regularly diagnosed by assessing the psoas muscle area only or the total muscle area at the cranio-caudal height of the third lumbar vertebra on axial CT. Studies on body composition mainly focus on two body components: skeletal muscle mass and muscle quality to assess sarcopenia and fat mass to assess obesity. As the utilization of computed tomography (CT) in the emergency department has substantially increased in the past years, there is a rising application of body composition assessment on these CT images that were previously taken for other clinical purposes. There has been an increasing interest in whether body composition affects outcomes in trauma patients in the past decade. In level-1 trauma patients without severe neurological injuries, automatically derived body composition parameters are able to independently predict an increased risk of specific complications and other poor outcomes. ![]() VF was associated with developing a delirium (OR 1.95, 95% CI 1.12–3.41). Psoas muscle radiation attenuation was independently associated with the development of any complication (OR 0.60, 95% CI 0.42–0.85), pneumonia (OR 0.63, 95% CI 0.41–0.96), and delirium (OR 0.49, 95% CI 0.28–0.87). ![]() Psoas muscle index was not independently associated with complications, but it was associated with ICU admission (odds ratio 0.79, 95% confidence interval 0.65–0.95), and an unfavorable Glasgow Outcome Scale (GOS) score at discharge (OR 0.62, 95% CI 0.45–0.85). Severe comorbidities (ASA 3–4) were seen in 10.9%, and the median ISS was 9 (IQR 5–14). The median age was 49 years (interquartile range 30–64), and 66.6% were male. ResultsĪ total of 404 patients were included for analysis. Multivariable logistic and linear regression analyses were performed to assess associations between body composition parameters and outcomes. ![]() An artificial intelligence (AI) algorithm was used to retrieve muscle areas to calculate the psoas muscle index and to retrieve psoas muscle radiation attenuation and visceral fat (VF) area from axial CT images. ![]() Trauma patients aged 16 years or older without severe neurological injuries, who underwent a CT that included the abdomen within 7 days of admission, were included. MethodsĪ retrospective cohort study was conducted on adult patients admitted to the University Medical Center Utrecht following a trauma between January 1 and December 31, 2017. The present study aims to assess whether CT-derived muscle mass, muscle density, and visceral fat mass are associated with in-hospital complications and clinical outcome in level-1 trauma patients. ![]()
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