CT-based determination of excessive visceral adipose tissue is associated with an impaired survival in critically ill patients

Abstract

Objective Obesity is a negative prognostic factor for various clinical conditions. In this observational cohort study, we evaluated a CT-based assessment of the adipose tissue distribution as a potential non-invasive prognostic parameter in critical illness. Methods Routine CT-scans upon admission to the intensive care unit (ICU) were used to analyze the visceral and subcutaneous adipose tissue areas at the 3rd lumbar vertebra in 155 patients. Results were correlated with various prognostic markers and both short-term- and overall survival. Multiple statistical tools were used for data analysis. Results We observed a significantly larger visceral adipose tissue area in septic patients compared to non-sepsis patients. Interestingly, patients requiring mechanical ventilation had a significantly higher amount of visceral adipose tissue correlating with the duration of mechanical ventilation. Moreover, both visceral and subcutaneous adipose tissue area significantly correlated with several laboratory markers. While neither the visceral nor the subcutaneous adipose tissue area was predictive for short-term ICU survival, patients with a visceral adipose tissue area above the optimal cut-off (241.4 cm2) had a significantly impaired overall survival compared to patients with a lower visceral adipose tissue area. Conclusions Our study supports a prognostic role of the individual adipose tissue distribution in critically ill patients. However, additional investigations need to confirm our suggestion that routine CT-based assessment of adipose tissue distribution can be used to yield further information on the patients’ clinical course. Moreover, future studies should address functional and metabolic analysis of different adipose tissue compartments in critical illness.

Low Serum Levels of Soluble Receptor Activator of Nuclear Factor κ B Ligand (sRANKL) Are Associated with Metabolic Dysregulation and Predict Long-Term Mortality in Critically Ill Patients

“…In reference to our study in critically ill patients, one could hypothesize that individual body composition might be associated with impaired long-term survival as initially low sRANKL levels might also affect bone metabolism and remodeling. Recent studies from our group highlighted the importance of the individual’s body composition reporting that excessive visceral adipose tissue, as well as sarcopenia and myosteatosis, are associated with poorer outcomes in critically ill patients [ 37 , 38 , 39 ], going in line with further studies discussing frailty as potential key determinant predicting complicated courses of disease and poorer long-term outcomes [ 40 ]. Numerous further functional pathways have been and are currently under investigation.…”

Establishment of a novel weight reduction model after laparoscopic sleeve gastrectomy based on abdominal fat area

“…Studies have shown that preoperative BMI, sex, and anthropometric indicators can predict the effect of postoperative weight loss (26,27). Psychological factors, marital relationships, and social factors that influence dietary behavior have also been explored in other studies (28)(29)(30)(31). Abdominal adipose tissue is closely related to obesity and obesity related metabolic disorders, but its impact on postoperative weight loss has remained relatively unexplored.…”

Serum Perilipin 2 (PLIN2) Predicts Multiple Organ Dysfunction in Critically Ill Patients

“…Computed tomography (CT) scan body composition analyses emerge as an attractive and potentially more reliable alternative in the ICU setting [41,42,64,[67][68][69]. Subsequently, a well-characterized subset of our ICU cohort underwent CT-scan body composition analyses.…”

“…Reconstructed slice thickness was 5 mm and only venous-phase scans were used for body composition calculations. According to the literature, there is a strong association between single-slice measurements and total compartment volumes [40][41][42]. Hence, total visceral and subcutaneous adipose tissue (VAT, SAT), skeletal muscle area and its mean attenuation given in Hounsfield units (HU) were segmented at the center plane of the third lumbar vertebra on axial CT scans.…”