Key result
CT-derived AATI is linked to ~16% longer ICU stays per SD, whereas BMI is not.
Why the study?
BMI does not differentiate between fat compartments, and CT-derived body composition may provide more accurate risk assessment in moderate and severe trauma patients.
Do CT-derived abdominal adiposity measurements better predict ICU length of stay and ventilation duration than BMI in moderate and severe trauma patients?
Cohort (n=142)
No
Do CT-derived abdominal adiposity measurements better predict ICU length of stay and ventilation duration than BMI in moderate and severe trauma patients?
Effect estimate: +15.5% per SD (95% CI 2.7-29.9)
p-value: p=0.016
CT-derived abdominal adiposity measurements are more strongly and consistently associated with ICU length of stay and ventilation duration than BMI in trauma patients.
AATI may better flag trauma patients for prolonged ICU stay than BMI; hypothesis-generating, needs prospective validation before any practice change.
BACKGROUND: Obesity as measured by body mass index (BMI) has been associated with worse clinical outcomes in moderate and severe trauma patients. However, while BMI does not differentiate between different fat compartments, routine CT-derived body composition provides detailed assessment and may thus provide more accurate risk assessment. METHODS: 200 eligible patients with moderate or severe trauma (injury severity score (ISS)≥ 9 from a level-1 trauma center were retrospectively identified and assembled into a 1:1 matched cohort (obese, BMI ≥ 30 kg/m vs. non-obese, BMI < 30 kg/m²), with exact matching on sex and close balancing on age and ISS. Patients with low quality CT imaging (n = 10), without intensive care unit (ICU) stay (n = 27) and death while hospital stay (n = 21) were excluded. CT-derived body composition measures including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), their respective indices (VATI, SATI) and a combined abdominal fat tissue index (AATI) were assessed from a single axial slice at the L3 vertebral level using a previously developed and validated deep learning segmentation model. RESULTS: A total of 142 ICU survivors formed the final study cohort (median age: 56 years (IQR 47-65), 16% female, 52% obese). VATI (ρ = 0.25 and 0.27, p = 0.003 and 0.001) and SATI (ρ = 0.19 and 0.24, p = 0.024 and 0.003) were significantly correlated with ICU length of stay (LOS) and ventilation duration, while BMI did not show a significant correlation. In a combined model with the BMI, AATI remained significant while BMI did not (+15.5% per SD; 95% CI 2.7-29.9%; p = 0.016 for ICU LOS; +30.8% per SD; 95% CI 12.4-52.3%; p < 0.001 for ventilation duration). CONCLUSION: CT-derived abdominal adiposity measurements from routine scans were more strongly and consistently associated with ICU LOS and ventilation duration than BMI. Thus, CT-based body composition analysis may improve individual risk assessment and management on ICU patients.
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Zander et al. (2026) conducted a cohort in Moderate and severe trauma (n=142). CT-derived abdominal fat tissue index (AATI) vs. Body mass index (BMI) was evaluated on ICU length of stay (+15.5% per SD, 95% CI 2.7-29.9, p=0.016). CT-derived combined abdominal fat tissue index (AATI) was significantly associated with increased ICU length of stay (+15.5% per SD; 95% CI 2.7-29.9%; p=0.016), whereas BMI was not.
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