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

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.