Body composition parameters in initial CT imaging of mechanically ventilated trauma patients: Single-centre observational study.

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2024-08-26 DOI:10.1002/jcsm.13578
Hans-Jonas Meyer, Tihomir Dermendzhiev, Michael Hetz, Georg Osterhoff, Christian Kleber, Timm Denecke, Jeanette Henkelmann, Robert Werdehausen, Gunther Hempel, Manuel F Struck
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Abstract

Background: Body composition parameters provide relevant prognostic significance in critical care cohorts and cancer populations. Published results regarding polytrauma patients are inconclusive to date. The goal of this study was to analyse the role of body composition parameters in severely injured trauma patients.

Methods: All consecutive patients requiring emergency tracheal intubation and mechanical ventilation before initial computed tomography (CT) at a level-1 trauma centre over a 12-year period (2008-2019) were reanalysed. The analysis included CT-derived body composition parameters based upon whole-body trauma CT as prognostic variables for 30-day mortality, intensive care unit length of stay (ICU LOS) and mechanical ventilation duration.

Results: Four hundred seventy-two patients (75% male) with a median age of 49 years, median injury severity score of 26 and 30-day mortality rate of 22% (104 patients) met the inclusion criteria and were analysed. Regarding body composition parameters, 231 patients (49%) had visceral obesity, 75 patients had sarcopenia (16%) and 35 patients had sarcopenic obesity (7.4%). After adjustment for statistically significant univariable predictors age, body mass index, sarcopenic obesity, visceral obesity, American Society of Anesthesiologists classification ≥3, injury severity score and Glasgow Coma Scale ≤ 8 points, the Cox proportional hazard model identified sarcopenia as significant prognostic factor of 30-day mortality (hazard ratio 2.84; 95% confidence interval 1.38-5.85; P = 0.004), which was confirmed in Kaplan-Meier survival analysis (log-rank P = 0.006). In a subanalysis of 363 survivors, linear multivariable regression analysis revealed no significant associations of body composition parameters with ICU LOS and duration of mechanical ventilation.

Conclusions: In a multivariable analysis of mechanically ventilated trauma patients, CT-defined sarcopenia was significantly associated with 30-day mortality whereas no associations of body composition parameters with ICU LOS and duration of mechanical ventilation were observed.

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机械通气创伤患者初始 CT 成像中的身体成分参数:单中心观察研究。
背景:身体成分参数对重症监护人群和癌症患者的预后具有重要意义。迄今为止,已发表的有关多发性创伤患者的研究结果尚无定论。本研究旨在分析身体成分参数在严重创伤患者中的作用:重新分析了一家一级创伤中心在 12 年内(2008-2019 年)首次进行计算机断层扫描(CT)前需要紧急气管插管和机械通气的所有连续患者。分析包括基于全身创伤 CT 的 CT 导出身体成分参数,作为 30 天死亡率、重症监护室住院时间(ICU LOS)和机械通气持续时间的预后变量:符合纳入标准的 422 名患者(75% 为男性)(104 人)的中位年龄为 49 岁,中位受伤严重程度评分为 26 分,30 天死亡率为 22%。在身体组成参数方面,231 名患者(49%)患有内脏肥胖症,75 名患者患有肌肉疏松症(16%),35 名患者患有肌肉疏松性肥胖症(7.4%)。在对具有统计学意义的单变量预测因素年龄、体重指数、肌肉疏松性肥胖、内脏肥胖、美国麻醉医师协会分类≥3、损伤严重程度评分和格拉斯哥昏迷量表≤8 分进行调整后,Cox 比例危险模型确定肌肉疏松症是 30 天死亡率的重要预后因素(危险比 2.84; 95% 置信区间 1.38-5.85; P = 0.004),卡普兰-米尔生存分析证实了这一点(log-rank P = 0.006)。在对363名幸存者进行的一项子分析中,线性多变量回归分析显示,身体成分参数与重症监护室的住院时间和机械通气的持续时间没有明显关系:结论:在对接受机械通气的创伤患者进行的多变量分析中,CT定义的肌肉疏松症与30天死亡率明显相关,而身体成分参数与重症监护室的住院时间和机械通气时间没有关系。
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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
自引率
12.40%
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0
期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
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