Stidham Ryan W, Waljee Akbar K, Day Nicholas M, Bergmans Carrie L, Zahn Katelin M, Higgins Peter D R, Wang Stewart C, Su Grace L
*Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; †VA Ann Arbor Health Services Research and Development Center for Clinical Management Research, Ann Arbor, Michigan; Departments of ‡Internal Medicine and §Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Inflamm Bowel Dis. 2015 Jun;21(6):1306-13. doi: 10.1097/MIB.0000000000000360.
BACKGROUND: Decisions between medical and surgical management of Crohn's disease (CD) incorporate risk assessments for potential complications of each therapy. Analytic morphomics is a novel method of image analysis providing quantifiable measurements of body tissue composition, characterizing body fat more comprehensively than body mass index alone. The aim of this study was to determine the risk factors associated with postoperative complications in CD, incorporating fat composition analysis using analytic morphomics. METHODS: We performed a retrospective review of adults undergoing bowel resection for CD between 2004 and 2011 at a single center. Computed tomography obtained within 30 days prior to surgery underwent morphomic analysis for fat characterization. Postoperative infectious complications were defined as the need for a postoperative abdominal drain, intravenous antibiotics, or reoperation within 30 days. Bivariate and multivariate analyses using logistic regression were used to generate a prediction model of infectious complications. RESULTS: A total of 269 subjects met selection criteria; 27% incurred postoperative infectious complications. Bivariate analysis showed hemoglobin, albumin, surgical urgency, high-dose prednisone use, and subcutaneous-to-visceral fat volume distribution as predictors of complications. Body mass index, anti-tumor necrosis factor alpha therapies, and immunomodulator use were not predictors of complication. Multivariate modeling demonstrated a c-statistic of 0.77 and a negative predictive value of 81.1% with surgical urgency (odds ratio = 2.78; 95% confidence interval, 1.46-6.02; P = 0.004), subcutaneous-to-visceral fat distribution (odds ratio = 2.01; 95% confidence interval, 1.20-3.19; P = 0.006), and hemoglobin (odds ratio = 0.69; 95% confidence interval, 0.55-0.85; P = 0.001) as predictors of infectious complication. CONCLUSIONS: Fat subtype and distribution are predictive of postoperative infectious complications after bowel resection for CD. Analytic morphomics provides additional body composition detail not captured by body mass index.
背景：克罗恩病（CD）的药物治疗与手术治疗决策需纳入对每种治疗潜在并发症的风险评估。分析形态学是一种新型图像分析方法，可提供身体组织成分的量化测量，比单独的体重指数更全面地描述身体脂肪。本研究的目的是确定CD术后并发症的相关危险因素，并纳入使用分析形态学的脂肪成分分析。 方法：我们对2004年至2011年在单一中心接受CD肠切除术的成年人进行了回顾性研究。术前30天内获得的计算机断层扫描进行形态学分析以进行脂肪特征描述。术后感染性并发症定义为术后需要腹腔引流、静脉使用抗生素或在30天内再次手术。使用逻辑回归进行双变量和多变量分析以生成感染性并发症的预测模型。 结果：共有269名受试者符合入选标准；27%发生了术后感染性并发症。双变量分析显示血红蛋白、白蛋白、手术紧迫性、高剂量泼尼松使用以及皮下与内脏脂肪体积分布是并发症的预测因素。体重指数、抗肿瘤坏死因子α治疗和免疫调节剂使用不是并发症的预测因素。多变量建模显示c统计量为0.77，阴性预测值为81.1%，手术紧迫性（比值比=2.78；95%置信区间，1.46 - 6.02；P = 0.004）、皮下与内脏脂肪分布（比值比=2.01；95%置信区间，1.20 - 3.19；P = 0.006）和血红蛋白（比值比=0.69；95%置信区间，0.55 - 0.85；P = 0.001）是感染性并发症的预测因素。 结论：脂肪亚型和分布可预测CD肠切除术后的感染性并发症。分析形态学提供了体重指数未捕捉到的额外身体成分细节。
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