Belger Esref, Truhn Daniel, Weber Christian David, Neumann Ulf Peter, Hildebrand Frank, Horst Klemens
Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany.
Department of Surgery and Transplantation, RWTH Aachen University Hospital, 52074 Aachen, Germany.
J Clin Med. 2023 Mar 27;12(7):2520. doi: 10.3390/jcm12072520.
Body mass composition (BC) was shown to correlate with outcome in patients after surgery and minor trauma. As BC is assessed using computed tomography (CT) and routinely applied in multiple trauma (MT), this study will help to analyze whether BC variables also correlate with outcome in trauma patients.
Inclusion criteria were MT (Injury Severity Score (ISS) > 15) and whole-body CT (WBCT) scan on admission. Muscle and fat tissue were assessed at the level of the fourth thoracic vertebra (T4) and the third lumbar vertebra (L3) using Slice-O-matic software, version 5.0 (Tomovision, Montreal, QC, Canada). Univariate and multivariate regression models were used with regard to outcome parameters such as duration of ventilation, hospital stay, local (i.e., pneumonia, wound infection) and systemic (i.e., MODS, SIRS) complications, and mortality.
297 patients were included. BC correlated with both the development and severity of complications. Skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at both T4 and L3 correlated positively with the occurrence of systemic infections. Local infections positively correlated with SMI at T4. Low muscle mass and high visceral adipose tissue (VAT) predicted the severity of systemic and local complications. Muscle tissue markers at both T4 and L3 predicted the severity of complications in roughly the same way. Moreover, higher muscle mass at the L3 level was significantly associated with higher overall survival, while SATI at the T4 level correlated positively with hospital stay, length of stay in the ICU, and duration of ventilation.
A lower muscle mass and a high adipose tissue index are associated with a poor outcome in MT. For the first time, it was shown that BC at the fourth thoracic vertebra is associated with comparable results to those found at the third lumbar level.
已表明身体成分（BC）与手术和轻度创伤后患者的预后相关。由于BC是通过计算机断层扫描（CT）评估的，并且在多发伤（MT）中常规应用，本研究将有助于分析BC变量是否也与创伤患者的预后相关。
纳入标准为MT（损伤严重度评分（ISS）>15）且入院时进行全身CT（WBCT）扫描。使用Slice-O-matic软件5.0版（Tomovision，加拿大魁北克省蒙特利尔）在第四胸椎（T4）和第三腰椎（L3）水平评估肌肉和脂肪组织。针对诸如通气时间、住院时间、局部（即肺炎、伤口感染）和全身（即多器官功能障碍综合征、全身炎症反应综合征）并发症以及死亡率等预后参数，使用单变量和多变量回归模型。
纳入297例患者。BC与并发症的发生和严重程度均相关。T4和L3水平的骨骼肌指数（SMI）和皮下脂肪组织指数（SATI）与全身感染的发生呈正相关。局部感染与T4水平的SMI呈正相关。低肌肉量和高内脏脂肪组织（VAT）预示全身和局部并发症的严重程度。T4和L3水平的肌肉组织标志物对并发症严重程度的预测方式大致相同。此外，L3水平较高的肌肉量与较高的总体生存率显著相关，而T4水平的SATI与住院时间、重症监护病房住院时间和通气时间呈正相关。
在多发伤中，较低的肌肉量和较高的脂肪组织指数与不良预后相关。首次表明第四胸椎水平处的身体成分与第三腰椎水平处的结果具有可比性。
