Background: Patients with obesity are also at risk for sarcopenia, which is difficult to recognize in this population. Our study examines whether sarcopenic-obesity (SO) is independently associated with mortality in trauma. Methods: Using a retrospective database, we performed logistic regression analysis. Admission CT scans were used to identify SO by calculating the visceral fat to skeletal muscle ratio >3.2. Results: Of 883 patients, the prevalence of SO was 38% (333). Patients with SO were more likely to be male (79% versus 43%, p < 0.001), older (mean 66.5 years versus 46.3 years, p < 0.001), and less likely to have an injury severity score (ISS) ≥ 24 (43% versus 55%, p = 0.0003). Using multivariable logistic regression analysis, SO was independently associated with mortality (OR 2.8; 95% CI 1.6–4.8, p < 0.001). Causal mediation analysis found admission hyperglycemia as a mediator for mortality. Conclusions: Sarcopenic obesity is an independent predictor of mortality in major trauma.
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