van Ee Elaine P X, Verheul Esmee A H, Dijkink Suzan, Krijnen Pieta, Veldhuis Wouter, Feshtali Shirin S, Avery Laura, Lucassen Claudia J, Mieog Sven D, Hwabejire John O, Schipper Inger B
Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R|, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3209-3215. doi: 10.1007/s00068-024-02624-6. Epub 2024 Aug 21.
This study explored if computerized tomography-derived body composition parameters (CT-BCPs) are related to malnutrition in severely injured patients admitted to the Intensive Care Unit (ICU).
This prospective cohort study included severely injured (Injury Severity Score ≥ 16) patients, admitted to the ICU of three level-1 trauma centers between 2018 and 2022. Abdominal CT scans were retrospectively analyzed to assess the CT-BCPs: muscle density (MD), skeletal muscle index (SMI), and visceral adipose tissue (VAT). The Subjective Global Assessment was used to diagnose malnutrition at ICU admission and on day 5 of admission, and the modified Nutrition Risk in Critically ill at admission was used to assess the nutritional risk.
Seven (11%) of the 65 analyzed patients had malnutrition at ICU admission, increasing to 23 patients (35%) on day 5. Thirteen (20%) patients had high nutritional risk. CT-BCPs were not related to malnutrition at ICU admission and on day 5. Patients with high nutritional risk at admission had lower MD (median (IQR) 32.1 HU (25.8-43.3) vs. 46.9 HU (37.7-53.3); p < 0.01) and higher VAT (median 166.5 cm (80.6-342.6) vs. 92.0 cm (40.6-148.2); p = 0.01) than patients with low nutritional risk.
CT-BCPs do not seem related to malnutrition, but low MD and high VAT may be associated with high nutritional risk. These findings may prove beneficial for clinical practice, as they suggest that CT-derived parameters may provide valuable information on nutritional risk in severely injured patients, in addition to conventional nutritional assessment and screening tools.
Level III, Prognostic/Epidemiological.
本研究探讨了计算机断层扫描得出的身体成分参数（CT-BCPs）是否与入住重症监护病房（ICU）的重伤患者的营养不良有关。
这项前瞻性队列研究纳入了2018年至2022年间入住三个一级创伤中心ICU的重伤（损伤严重程度评分≥16）患者。对腹部CT扫描进行回顾性分析以评估CT-BCPs：肌肉密度（MD）、骨骼肌指数（SMI）和内脏脂肪组织（VAT）。采用主观全面评定法在ICU入院时和入院第5天诊断营养不良，并采用入院时改良的危重症营养风险评估法评估营养风险。
65例分析患者中，7例（11%）在ICU入院时存在营养不良，入院第5天时增至23例（35%）。13例（20%）患者有高营养风险。CT-BCPs与ICU入院时及入院第5天的营养不良无关。入院时高营养风险患者的MD较低（中位数（IQR）32.1 HU（25.8 - 43.3）对46.9 HU（37.7 - 53.3）；p < 0.01），VAT较高（中位数166.5 cm（80.6 - 342.6）对92.0 cm（40.6 - 148.2）；p = 0.01），而营养风险低的患者则相反。
CT-BCPs似乎与营养不良无关，但MD低和VAT高可能与高营养风险相关。这些发现可能对临床实践有益，因为它们表明，除了传统的营养评估和筛查工具外，CT得出的参数可能为重伤患者的营养风险提供有价值的信息。
三级，预后/流行病学。
