Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi.
Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi.
J Surg Res. 2023 Dec;292:190-196. doi: 10.1016/j.jss.2023.07.048. Epub 2023 Aug 24.
Anatomic distribution of adipose tissue has demonstrated variable associations with hypercoagulability. Utilizing a retrospective analysis of a previously enrolled prospective cohort, we assessed computed tomography (CT) scan-based anthropometric and volumetric measures of adiposity as predictors of postinjury hypercoagulability.
Segmentation analysis of arrival CT scans in significantly injured patients at a single level-I trauma center enrolled from December 2017 to August 2021 were analyzed for anthropometric indices of waist circumference (WC) and sagittal abdominal diameter (SAD), and volumetric parameters of visceral adipose tissue, superficial/deep subcutaneous adipose tissue, psoas/paravertebral muscle volume, and abdominal wall muscle volume. Associations with thromboelastography (TEG) were explored.
Data from 91 patients showed strong correlations between body mass index and standard anthropometric measures of WC and SAD (P < 0.001); calculated volumes of subcutaneous adipose tissue and visceral adipose tissue (P < 0.001); and ratios of subcutaneous adipose:psoas muscle (SP ratio) and visceral adipose:psoas muscle ratio (both with P < 0.001, respectively). Correlation between TEG maximal amplitude (MA) and body mass index and SAD were not significant, with only weak correlation between TEG-MA and WC (r = 0.238, P = 0.041). Moderate but significant correlations existed between SP ratio and TEG-MA (r = 0.340, P = 0.005), but not visceral adipose:psoas muscle ratio (r = 0.159, P = 0.198). The relationship between TEG-MA and SP ratio remained significant when adjusted for injury severity score and lactate level (b = 0.302, P = 0.001).
SP ratio is more strongly correlated with TEG-MA than standard obesity measures, and independently predicts increasing clot strength/stability after injury. Coagulation-relevant measures of sarcopenic obesity can be measured on CT scan, and may be used to optimize thromboprophylaxis strategies for obese injured patients.
脂肪组织的解剖分布与高凝状态存在多种关联。本研究利用一项之前注册的前瞻性队列的回顾性分析，评估基于计算机断层扫描（CT）的人体测量学和脂肪体积测量指标作为受伤后高凝状态的预测因子。
对 2017 年 12 月至 2021 年 8 月期间在一家一级创伤中心因严重损伤而入院的患者的 CT 扫描进行分割分析，以评估腰围（WC）和矢状腹部直径（SAD）的人体测量学指数，以及内脏脂肪组织、浅层/深层皮下脂肪组织、腰大肌/椎旁肌体积和腹壁肌肉体积的体积参数。并探讨了这些参数与血栓弹性图（TEG）的相关性。
91 例患者的数据显示，体重指数与 WC 和 SAD 的标准人体测量学指标（P<0.001）；皮下脂肪组织和内脏脂肪组织的计算体积（P<0.001）；以及皮下脂肪/腰大肌比（SP 比）和内脏脂肪/腰大肌比（两者均为 P<0.001）之间存在很强的相关性。TEG 最大振幅（MA）与体重指数和 SAD 之间的相关性不显著，而 TEG-MA 与 WC 之间仅有弱相关性（r=0.238，P=0.041）。SP 比与 TEG-MA 之间存在中度但显著的相关性（r=0.340，P=0.005），而内脏脂肪/腰大肌比与 TEG-MA 之间无相关性（r=0.159，P=0.198）。在调整损伤严重程度评分和乳酸水平后，TEG-MA 与 SP 比之间的关系仍然显著（b=0.302，P=0.001）。
SP 比与 TEG-MA 的相关性强于标准肥胖指标，可独立预测受伤后血栓强度/稳定性的增加。CT 扫描可测量与凝血相关的肌肉减少性肥胖指标，可用于优化肥胖受伤患者的血栓预防策略。
