๐ค Authors: Leanne L G C Ackermans, Jasper C Stokroos, David P J Van Dijk, Bjorn Winkens, Martijn Poeze, Leonard Wee, Ralph Brecheisen, Steven M W Olde Damink, Jan A Ten Bosch, Taco J Blokhuis
Subcutaneous Adipose Tissue Radiation Attenuation Is Associated With Increased 1-Year Mortality in Polytrauma Patients.
<p><b>BACKGROUND</b></p><p>Polytrauma patients with an Injury Severity Score (ISS)โโฅโ16 have a high mortality rate. Early identification of patients at risk of mortality is key.
Different risk stratification models are available; however, body composition on third lumbar computed tomography (L3 CT) is not routinely used. The aim of this study is to determine the effect of CT body composition on 1-year mortality in adult polytrauma patients.</p><p><b>METHODS</b></p><p>Body composition analysis (L3 CT) was performed on 593 adult polytrauma patients.
The associations with 1-year mortality were assessed using uni- and multivariable logistic regression analysis. As a sensitivity analysis, 1-year mortality was analysed using Kaplan-Meier survival curves, log-rank tests and Cox regression.</p><p><b>RESULTS</b></p><p>The study population was predominantly male (69.5%), with a mean age of 55 (ยฑ20) years and an average BMI of 25.34โkg/m 2 (ยฑ4.07).
Comorbidities were present in 327 (55.4%) patients, with an average Charlson Comorbidity Index (CCI) of 2.07 points (ยฑ2.1). The mean ISS score was 27.59 (ยฑ11.06); 323 (54.5%) patients had an ISSโโฅโ25 points.
Age, CCI, ISS, skeletal muscle index and skeletal muscle radiation attenuation (OR 1.053, 5.713, 3.711, 0. 563 and 0.533, respectively; pโ<โ0.001), subcutaneous adipose tissue radiation attenuation (SATRA OR 1.253, pโ=โ0.028) and visceral adipose tissue index (OR 1.242, pโ=โ0.038) were significantly associated with 1-year mortality. In multivariable logistic regression, age, ISS and SATRA remained statistically significantly associated with 1-year mortality (OR 1.062, pโ<โ0.001; OR 4.761, pโ<โ0.001; OR 1.396, pโ=โ0.009).</p><p><b>CONCLUSIONS</b></p><p>This study demonstrated that subcutaneous adipose tissue radiation attenuation on emergency trauma CT scans is significantly associated with 1-year mortality in adult polytrauma patients.
Additionally, we found a significant effect of age and ISS on 1-year mortality. Incorporating body composition analysis could lead to a better selection of patients at risk for 1-year mortality and aid in treatment decision-making.</p>
