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

Wirtz, Theresa H.; Loosen, Sven H.; Schulze-Hagen, Maximilian; Weiskirchen, Ralf; Buendgens, Lukas; Abu Jhaisha, Samira; Brozat, Jonathan F.; Puengel, Tobias; Vucur, Mihael; Paffenholz, Pia; Kuhl, Christiane; Tacke, Frank; Trautwein, Christian; Luedde, Tom; Roderburg, Christoph; Koch, Alexander

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 3(rd) 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 cm(2)) 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.