Adiposity and Coagulation: Predicting Postinjury Coagulation With Advanced Imaging Analysis.

Area of Science:

• Trauma research
• Obesity and metabolism
• Coagulation science

Background:

• Adipose tissue distribution is variably linked to hypercoagulability.
• Standard obesity measures have shown inconsistent associations with post-injury hypercoagulability.
• Computed tomography (CT) scans offer detailed body composition analysis.

Purpose of the Study:

• To assess CT-derived anthropometric and volumetric adiposity measures as predictors of post-injury hypercoagulability.
• To explore associations between body composition metrics and thromboelastography (TEG) in trauma patients.
• To identify optimal imaging-based markers for predicting clot strength after injury.

Main Methods:

• Retrospective analysis of a prospective cohort of significantly injured patients.
• Segmentation analysis of arrival CT scans to determine anthropometric (waist circumference, sagittal abdominal diameter) and volumetric (visceral adipose tissue, subcutaneous adipose tissue, muscle volumes) parameters.
• Exploration of associations between these measures and TEG parameters, specifically maximal amplitude (MA).

Main Results:

• Strong correlations were found between body mass index, standard anthropometrics, and adipose tissue volumes.
• The subcutaneous adipose to psoas muscle (SP) ratio showed a moderate, significant correlation with TEG-MA (r=0.340, P=0.005).
• The SP ratio independently predicted increasing clot strength/stability after injury, even after adjusting for injury severity and lactate levels.

Conclusions:

• The SP ratio is a stronger predictor of hypercoagulability than standard obesity measures in injured patients.
• CT-derived measures of sarcopenic obesity can be quantified and utilized.
• These findings may inform optimized thromboprophylaxis strategies for obese trauma patients.