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Background <p>Enterocutaneous fistula (ECF) patients face complex metabolic and immunological perturbations, creating “nutri-inflammatory exhaustion” that increases vulnerability to catheter-related bloodstream infections (CRBSI). Body composition analysis may predict organ damage following CRBSI treatment in these high-risk patients.</p> Methods <p>This retrospective cohort study analyzed 146 ECF patients with confirmed CRBSI from two tertiary hospitals (November 2019–May 2024). CT-based body composition analysis calculated visceral fat area to total abdominal muscle area index ratio (VFA/TAMAI). The primary outcome was aggravated organ damage, defined as &gt; 2-point increase in Sequential Organ Failure Assessment score for any organ system following catheter removal. Restricted cubic splines analysis explored dose–response relationships, and multiple predictive models were compared.</p> Results <p>Aggravated organ damage occurred in 41 patients (28.1%). VFA/TAMAI demonstrated a J-shaped association with organ damage risk. The optimal cut-off value was 2.2, with 57 patients (39%) exceeding this threshold. Patients with VFA/TAMAI &gt; 2.2 had significantly higher risk of aggravated organ damage (adjusted OR: 3.72, 95% CI: 1.59–8.75, <i>P</i> = 0.002). Logistic regression outperformed support vector machine and Elastic Net models (AUC: 0.863 vs 0.771 vs 0.805). Including VFA/TAMAI significantly improved model performance compared to clinical variables alone (0.863 vs 0.814, <i>P</i> = 0.030).</p> Conclusion <p>VFA/TAMAI ratio serves as a valuable predictor of organ damage following CRBSI treatment in ECF patients, potentially enabling risk stratification and personalized management strategies.</p>

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VFA/TAMAI predicts aggravated organ damage after central line removal due to catheter-related bloodstream infection in patients with enterocutaneous fistula

  • 期刊论文

  • 发表日期：

    2026年4月9日

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  • Zhan Yu,
  • Lei Luo,
  • Risheng Zhao,
  • Yunzhao Zhao,
  • Zheng Yao,
  • Xin Xu

摘要

Background

Enterocutaneous fistula (ECF) patients face complex metabolic and immunological perturbations, creating “nutri-inflammatory exhaustion” that increases vulnerability to catheter-related bloodstream infections (CRBSI). Body composition analysis may predict organ damage following CRBSI treatment in these high-risk patients.

Methods

This retrospective cohort study analyzed 146 ECF patients with confirmed CRBSI from two tertiary hospitals (November 2019–May 2024). CT-based body composition analysis calculated visceral fat area to total abdominal muscle area index ratio (VFA/TAMAI). The primary outcome was aggravated organ damage, defined as > 2-point increase in Sequential Organ Failure Assessment score for any organ system following catheter removal. Restricted cubic splines analysis explored dose–response relationships, and multiple predictive models were compared.

Results

Aggravated organ damage occurred in 41 patients (28.1%). VFA/TAMAI demonstrated a J-shaped association with organ damage risk. The optimal cut-off value was 2.2, with 57 patients (39%) exceeding this threshold. Patients with VFA/TAMAI > 2.2 had significantly higher risk of aggravated organ damage (adjusted OR: 3.72, 95% CI: 1.59–8.75, P = 0.002). Logistic regression outperformed support vector machine and Elastic Net models (AUC: 0.863 vs 0.771 vs 0.805). Including VFA/TAMAI significantly improved model performance compared to clinical variables alone (0.863 vs 0.814, P = 0.030).

Conclusion

VFA/TAMAI ratio serves as a valuable predictor of organ damage following CRBSI treatment in ECF patients, potentially enabling risk stratification and personalized management strategies.