Image-based assessment of sarcopenic obesity predicts mortality in major trauma

John S Oh; Anna E Ssentongo; Paddy Ssentongo; Thomas Dykes; Laura Keeney; Scott B Armen; David I Soybel

doi:10.1016/j.amjsurg.2021.06.007

Image-based assessment of sarcopenic obesity predicts mortality in major trauma

Am J Surg. 2022 Apr;223(4):792-797. doi: 10.1016/j.amjsurg.2021.06.007. Epub 2021 Jun 18.

Authors

John S Oh¹, Anna E Ssentongo², Paddy Ssentongo³, Thomas Dykes⁴, Laura Keeney², Scott B Armen², David I Soybel⁵

Affiliations

¹ Department of Surgery, The Pennsylvania State University, College of Medicine, PO Box 850, Hershey, PA, 17033, USA. Electronic address: johnoh1@pennstatehealth.psu.edu.
² Department of Surgery, The Pennsylvania State University, College of Medicine, PO Box 850, Hershey, PA, 17033, USA.
³ Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, 101 Hammond Building, University Park, PA, 16802, USA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, PO Box, 850, Hershey, PA, 17033, USA.
⁴ Department of Radiology, Texas Tech University Health Sciences Center, 5001 El Paso Drive, El Paso, TX, 79905, USA.
⁵ Surgery Service, Dartmouth Geisel School of Medicine, Department of Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT, 05009, USA.

PMID: 34172258
DOI: 10.1016/j.amjsurg.2021.06.007

Abstract

Background: Patients with obesity are also at risk for sarcopenia, which is difficult to recognize in this population. Our study examines whether sarcopenic-obesity (SO) is independently associated with mortality in trauma.

Methods: Using a retrospective database, we performed logistic regression analysis. . Admission CT scans were used to identify SO by calculating the visceral fat to skeletal muscle ratio >3.2.

Results: Of 883 patients, the prevalence of SO was 38% (333). Patients with SO were more likely to be male (79% versus 43%, p < 0.001), older (mean 66.5 years versus 46.3 years, p < 0.001), and less likely to have an injury severity score (ISS) ≥ 24 (43% versus 55%, p = 0.0003). Using multivariable logistic regression analysis, SO was independently associated with mortality (OR 2.8; 95% CI 1.6-4.8, p < 0.001). Causal mediation analysis found admission hyperglycemia as a mediator for mortality.

Conclusions: Sarcopenic obesity is an independent predictor of mortality in major trauma.

Keywords: Critical care; Diabetes; Obesity; Sarcopenia; Sarcopenic obesity; Trauma.

MeSH terms

Female
Humans
Intra-Abdominal Fat / diagnostic imaging
Male
Muscle, Skeletal
Obesity / epidemiology
Retrospective Studies
Sarcopenia* / complications
Sarcopenia* / diagnostic imaging
Sarcopenia* / epidemiology