The correlation of CT-derived muscle density, skeletal muscle index, and visceral adipose tissue with nutritional status in severely injured patients

Elaine P X van Ee; Esmee A H Verheul; Suzan Dijkink; Pieta Krijnen; Wouter Veldhuis; Shirin S Feshtali; Laura Avery; Claudia J Lucassen; Sven D Mieog; John O Hwabejire; Inger B Schipper

doi:10.1007/s00068-024-02624-6

The correlation of CT-derived muscle density, skeletal muscle index, and visceral adipose tissue with nutritional status in severely injured patients

Eur J Trauma Emerg Surg. 2024 Aug 21. doi: 10.1007/s00068-024-02624-6. Online ahead of print.

Authors

Elaine P X van Ee^{1

2}, Esmee A H Verheul³, Suzan Dijkink^{3

4}, Pieta Krijnen^{3

5}, Wouter Veldhuis⁶, Shirin S Feshtali⁷, Laura Avery⁸, Claudia J Lucassen⁹, Sven D Mieog¹⁰, John O Hwabejire¹¹, Inger B Schipper³

Affiliations

¹ Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R|, P.O. Box 9600, Leiden, 2300 RC, The Netherlands. e.p.x.van_ee@lumc.nl.
² Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. e.p.x.van_ee@lumc.nl.
³ Department of Trauma Surgery, Leiden University Medical Center, Post zone K6-R|, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
⁴ Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
⁵ Acute Care Network West Netherlands, Leiden, the Netherlands.
⁶ Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Department of Dietetics, Leiden University Medical Center, Leiden, The Netherlands.
¹⁰ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
¹¹ Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

PMID: 39167212
DOI: 10.1007/s00068-024-02624-6

Abstract

Background: 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).

Methods: 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.

Results: 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 cm² (80.6-342.6) vs. 92.0 cm² (40.6-148.2); p = 0.01) than patients with low nutritional risk.

Conclusion: 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 of evidence: Level III, Prognostic/Epidemiological.

Keywords: Critical care; Multicenter; Nutrition; Nutritional status; Trauma.