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Impact of pathologic body composition assessed by CT-based anthropometric measurements in adult patients with multiple trauma: a retrospective analysis

  • Balázs PorosEmail author
  • Thomas Irlbeck
  • Philipp Probst
  • Alexander Volkmann
  • Philipp Paprottka
  • Wolfgang Böcker
  • Michael Irlbeck
  • Thomas Weig
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Obesity Sarcopenia Multiple trauma Anthropometry 

Abbreviations

AIS

Abbreviated injury scale

BMI

Body mass index

CNS

Central nervous system

DGU

German Society for Trauma Surgery

DICOM

Digital Imaging and Communications in Medicine

ED

Emergency department

GCS

Glasgow Coma Scale

GOS

Glasgow Outcome Scale

RBC

Red blood cell

SAD

Sagittal abdominal diameter

SBP

Systolic blood pressure

SAPS II

Simplified acute physiology score

SAT

Subcutaneous adipose tissue

SMI

Skeletal muscle index

SOFA

Sequential organ failure assessment

TMA

Total muscle area

VAT

Visceral adipose tissue

WBC

White blood cell

Notes

Acknowledgements

The authors thank Anne Guo for comments that greatly improved the manuscript.

Author contributions

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.

Funding

None.

Compliance with ethical standards

Conflict of interests

The authors declare that they have no competing interests.

Ethics approval

The present study was approved by the local institutional review board (UE no. 71-15).

Informed consent

The requirement to obtain an informed consent form was waived.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Balázs Poros
    • 1
    Email author
  • Thomas Irlbeck
    • 1
  • Philipp Probst
    • 2
  • Alexander Volkmann
    • 2
  • Philipp Paprottka
    • 3
  • Wolfgang Böcker
    • 4
  • Michael Irlbeck
    • 1
  • Thomas Weig
    • 1
  1. 1.Department of AnaesthesiologyUniversity Hospital, LMU MunichMunichGermany
  2. 2.Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of MedicineLMU MunichMunichGermany
  3. 3.Department of Interventional Radiology, Klinikum Rechts Der IsarTechnical University of MunichMunichGermany
  4. 4.Department of General, Trauma and Reconstructive SurgeryUniversity Hospital, LMU MunichMunichGermany

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