The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients—A Retrospective Study

Abstract

Objectives In recent years; increasing evidence pointed out the clinical importance of adipose tissue (AT) distribution in various patient populations. In particular, visceral adipose tissue (VAT), when compared to subcutaneous adipose tissue (SAT), was found to play a pivotal role in the development of inflammatory reaction. The aim of the present study was to examine whether body fat distribution has an impact on the development of systemic inflammatory response syndrome (SIRS) in patients with polytrauma. Methods In our retrospective study; we filtered our institution records of the German Trauma Registry (Trauma Register DGU) from November 2018 to April 2021 and included 132 adult polytrauma patients with injury severity score (ISS) >16. Subsequently; we measured the visceral and subcutaneous adipose tissue area based on whole-body CT scan and calculated the ratio of VAT to SAT (VSr). Thereafter, the patient population was evenly divided into three groups; respectively VSr value less than 0.4 for the first group (low ratio), 0.4–0.84 for the second group (intermediate ratio), and greater than 0.84 for the third group (high ratio). Considering the other influencing factors; the groups were further divided into subgroups in the respective analysis according to gender (male/female), BMI (<25 or ≥25), and ISS (<26 or ≥26). Result VSr was an independent factor from body mass index (BMI) (r2 = 0.003; p = 0.553). VSr in male patients was significantly higher (p < 0.001). Patients with low VSr had higher ISS scores (p = 0.028). Polytrauma patients with higher VSr tended to have lower SIRS scores and significant differences of SIRS score were found on multiple days during the whole hospitalization period. In the low VAT/SAT group, male patients, and patients with BMI greater than 25, both exhibited higher SIRS scores during hospital stay (day 16: p = 0.01; day 22: p = 0.048 and p = 0.011; respectively). During hospitalization, patients with higher ISS score (≥26) in the low VSr group was found to have higher SIRS score (day 16; p = 0.007). Over the hospital stay; serum markers of CRP; CK; and leukocyte in patients with low VSr were higher than those in patients in the intermediate and high VSr groups; with significant difference discovered on multiple days (day 16: 0.014; day 22: p = 0.048). Conclusion Lower VSr is associated with increased inflammatory response and worse clinical outcome in patients with polytrauma. Furthermore; VSr is an independent factor providing additional information to BMI.

High Fat-to-Muscle Ratio Was Associated with Increased Clinical Severity in Patients with Abdominal Trauma

“…Two prior studies have shown that visceral to subcutaneous adipose tissue distribution was not associated with increased inflammatory profiles or clinical outcomes after trauma [ 40 , 41 ]. However, a recent study found that lower visceral to subcutaneous adipose tissue distribution was associated with increased inflammatory response and worse clinical outcomes in multiple trauma patients [ 28 ]. In this study, we have examined whether body fat distribution by calculating the VATI/SATI ratio has an impact on abdominal trauma patients as well, but no significant associations were found between the VATI/SATI ratio and clinical outcomes ( Supporting information Table S1 ).…”

“…We further calculated fat-to-muscle area ratios including the total fat-to-muscle area ratio (FTI/SMI), subcutaneous fat-to-muscle area ratio (SATI/SMI), and visceral fat-to-muscle area ratio (VATI/SMI) to assess the combined effects of fat and skeletal muscle on abdominal trauma patients [ 27 ]. In addition, the visceral-to-subcutaneous fat area ratio (VATI/SATI) was computed to evaluate the impact of fat distribution on trauma patients [ 28 ]. All these indices were divided into low and high groups according to sex-specific median cutoff values [ 29 ].…”

Predictive influence of artificial intelligence‐based body composition analysis in trauma patients with pelvic injuries

“…State‐of‐the‐art image segmentation tools can automatically differentiate subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and muscle tissue, represented as skeletal muscle index (SMI) and psoas muscle index (PMI) 19 . This body composition analysis (BCA) enables the identification of risk factors based on muscle and fat distribution and has been used successfully in the evaluation of the inflammatory response after polytrauma and also in areas such as oncological surgery and organ transplantation 20–22 . For example, in oesophageal cancer, body composition has been shown to predict severe complications, prolonged hospitalization, and overall survival, 20,23 and in elderly kidney transplant recipients, obesity and sarcopenia are significant risk factors for 1‐ and 5‐year transplant survival, respectively 21 .…”

“…11 The injury severity score (ISS) is an established tool for initial trauma assessment and can be used for risk stratification. After calculation of the overall score, trauma patients can be grouped into different ISS categories: mild (ISS 1-3), moderate (ISS 4-8), serious (ISS 9-15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), and critical . A higher ISS category is associated with poorer outcome in terms of mortality and morbidity and longer hospitalization after trauma.…”

Healing after Trauma—New Knowledge and Procedures for the Benefit of Our Patients

“…Furthermore, two publications deal with the inflammatory response after multiple traumas. In a retrospective study, Chen et al evaluated the effect of fat distribution (visceral adipose tissue vs. subcutaneous adipose tissue) on the development of systemic inflammatory response syndrome in multiple trauma patients [ 7 ]. The results showed that lower visceral adipose tissue is associated with increased inflammatory response and worse clinical outcome in patients with polytrauma.…”