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The prognostic value of CT-quantified visceral and subcutaneous fat areas in sepsis
Tiancao Dong1, Dianyin Yang1,2, Jin Liu2
11Department of Internal Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
Background:
This study aims to investigate the prognostic value of computed tomography (CT)-quantified visceral fat area (VFA) and subcutaneous fat area (SFA) in sepsis.
Methods:
This study comprised a retrospective cohort (n=347) between January 2022 and July 2024 and a prospective internal validation cohort (n=160) between August 2024 and February 2025, all enrolling sepsis patients defined by the Sepsis-3 criteria. Abdominal CT at the third lumbar vertebra (L3) was used for VFA and SFA quantification. Prognostic factors for 28-day mortality were identified through least absolute shrinkage and selection operator (LASSO) regression and multivariable analysis. A nomogram was developed and validated using discrimination, calibration, and decision curve analysis (DCA).
Results:
The retrospective cohort demonstrated area under the curve (AUC) values of 0.74 (95% CI 0.66-0.82) (VFA) and 0.76 (95% CI 0.69-0.84) (SFA) for 28-day mortality prediction. The nomogram, incorporating VFA, SFA, lactate (LAC), total cholesterol (TC), age, septic shock, and procalcitonin (PCT), was found to outperform Sequential Organ Failure Assessment (SOFA) and Acute Physiology And Chronic Health Evaluation (APACHE) II scores with an AUC of 0.93 (95% CI 0.89-0.96) compared to 0.84 and 0.82.
Conclusion:
The CT-based nomogram integrating adiposity metrics provides a valuable prognostic tool for sepsis patients, though optimal adiposity ranges require further investigation.
