Abstract
Background
Aging, inactivity, and malnutrition are risk factors for adverse in-hospital outcomes and can manifest in bone loss. Use of bone mineral density (BMD) as an objective marker might improve early identification of patients at risk for complications.
Aim
To assess the association of computed tomography (CT) determined BMD values of the first lumbar vertebra with in-hospital complications and outcomes in trauma patients.
Methods
All consecutive hospitalized trauma patients (≥ 16 years) that underwent CT-imaging within 7 days of admission in 2017 were included. Patients with an active infection or antibiotic treatment upon admission, severe neurologic trauma, or an unassessable vertebra were excluded. BMD at the first lumbar vertebra was determined with CT by placing a circular region of interest in homogeneous trabecular bone to obtain mean Hounsfield Units (HU). Regression analyses were performed to assess the association of BMD with in-hospital complications and outcomes.
Results
In total, 410 patients were included (median age: 49 years [interquartile range 30–64], 68.3% men, mean BMD 159 ± 66 HU). A total of 94 complications, primarily infection-related, were registered in 74 patients. After adjustment for covariates, a decrease of BMD by one standard deviation was significantly associated with increased risk of complications (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–3.1), pneumonia (OR 2.2, 95% CI 1.2–4.5), delirium (OR 4.5, 95% CI 1.7–13.5), and intensive care unit (ICU) admission (OR 1.8, 95% CI 1.1–2.9).
Conclusion
Bone mineral density of the first lumbar vertebra is independently associated with in-hospital complications, pneumonia, delirium, and ICU admission. These findings could help identify patients at risk early.
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Data availability
The study data will not be made available.
Abbreviations
- ASA:
-
American Society of Anesthesiologists
- BMD:
-
Bone mineral density
- CI:
-
Confidence interval
- CT:
-
Computed tomography
- DMV:
-
Days on mechanical ventilation
- GOS:
-
Glasgow Outcome Scale
- HLOS:
-
Hospital length of stay
- HU:
-
Hounsfield Units
- ICU:
-
Intensive care unit
- ILOS:
-
ICU length of stay
- IQR:
-
Interquartile range
- ISS:
-
Injury Severity Score
- L1/L2:
-
First/second lumbar vertebra
- OR:
-
Odds ratio
- ROI:
-
Region of interest
- SD:
-
Standard deviation
- Th12:
-
Twelfth thoracic vertebra
- UMCU:
-
University Medical Center Utrecht
- UTI:
-
Urinary tract infection
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Acknowledgements
Our special thanks go out to Sandra A Wilson for her help in reviewing the manuscript on grammar and linguistics. Her efforts greatly increased the readability of the manuscript and the delivery of its message.
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Conceptualization, all authors; methodology, TK, AS, PdJ, and MvB.; formal analysis, TK, and AS; investigation, TK, AS, and SV; writing—original draft preparation, TK, and AS; writing—review & editing, SV, RH, WV, LL, PdJ, and MvB; visualization, TK, and AS; supervision, RH, WV, LL, PdJ, and MvB. All authors have read and agreed to the published version of the manuscript.
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None of the declarations of interest posed any conflict with conducting this study. Pim de Jong is a consultant for Sanifit and InoZyme. Wouter Veldhuis is co-founder of Quantib-U, a spin-off from the University Medical Center Utrecht. The Department of Radiology at the University Medical Center Utrecht is receiving research support from Philips Healthcare.
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Ethical approval was waived by the medical ethical committee of the University Medical Center Utrecht in view of the retrospective nature of the study and all the procedures being performed were part of routine care.
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Kobes, T., Sweet, A.A.R., Verstegen, S.B.H. et al. Computed tomographic bone mineral density is independently associated with adverse in-hospital outcomes in Dutch level-1 trauma patients. Eur J Trauma Emerg Surg 49, 1393–1400 (2023). https://doi.org/10.1007/s00068-022-02175-8
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DOI: https://doi.org/10.1007/s00068-022-02175-8