目的是探索通过术前腹部计算机断层扫描（CT）测量的内脏肥胖（VO）对结直肠癌（CRC）患者术后感染并发症的影响，并建立预测模型。研究纳入了2015年1月至2021年1月间接受结直肠癌切除的患者。所有患者在术前测量了体重指数（BMI）和内脏脂肪面积（VFA）。根据BMI和VO分类，比较了不同组之间的感染并发症。采用单变量和多变量 logistic 回归分析 VO 是否是术后感染并发症的独立危险因素。根据回归分析结果，采用了六种机器学习方法建立预测模型并进行内部验证。通过 SHAPley Additive exPlanations（SHAP）值解释了效果最好的模型。约有520名患者中大约有64.81%患有 VO。VO 与术后感染并发症（P＜0.001）、冠心病（P＝0.004）、脑梗死（P＝0.001）、高血压（P＜0.001）、糖尿病（P＜0.001）和脂肪肝（P＜0.001）显著相关。VO 患者的切口感染率（P＝0.048）、腹腔或盆腔感染率（P＝0.006）和肺炎率（P＝0.008）明显增加。与低 BMI 组相比，高 BMI 与高血压（P＝0.007）、脂肪肝（P＜0.001）以及术后感染率增加（P＝0.003）显著相关。回归分析结果显示 VO（OR＝2.01，95% CI 1.17~3.48，P＝0.012）、手术时间≥4小时（OR＝2.52，95% CI 1.60~3.97，P＜0.001）、吸烟（OR＝2.04，95% CI 1.16~3.59，P＝0.014）、造口（OR＝1.65，95% CI 1.04~2.61，P＝0.033）和慢性阻塞性肺疾病（COPD）（OR＝2.23，95% CI 1.09~4.57，P＝0.029）是独立危险因素。轻梯度提升机（LGBM）模型显示出最大的受试者工作特征曲线下面积（AUC）（0.74，95% CI 0.68~0.81）。本研究表明，在评估肠癌患者肥胖对代谢合并症和术后感染并发症的影响时，VO 优于BMI。© 2023. BioMed Central Ltd., part of Springer Nature.

To explore the impact of visceral obesity (VO) measured by preoperative abdominal computed tomography (CT) on postoperative infectious complications for colorectal cancer (CRC) patients and establish a predictive model.Patients who underwent resection for colorectal cancer between January 2015 and January 2021 were enrolled in this study. All patients were measured for body mass index (BMI) and visceral fat area (VFA) preoperatively. Infectious complications were compared between the different groups according to BMI and VO categories. Univariate and multivariate logistic regression were used to analyze whether VO was an independent risk factor for postoperative infectious complications. According to the results of logistic regression, six machine learning approaches were used to establish predictive models and perform internal validation. The best-performing model was interpreted by the SHAPley Additive exPlanations value.Approximately 64.81% of 520 patients had VO. VO was significantly connected with postoperative infectious complications (P < 0.001), coronary heart disease (P = 0.004), cerebral infarction (P = 0.001), hypertension (P < 0.001), diabetes (P < 0.001), and fatty liver (P < 0.001). The rates of wound infection (P = 0.048), abdominal or pelvic infection (P = 0.006), and pneumonia (P = 0.008) increased obviously in patients with VO. Compared to the low BMI group, a high BMI was found to be significantly associated with hypertension (P=0.007), fatty liver (P＜0.001), and a higher rate of postoperative infection (P=0.003). The results of logistic regression revealed that VO (OR = 2.01, 95% CI 1.17 ~ 3.48, P = 0.012), operation time ≥ 4 h (OR = 2.52, 95% CI 1.60 ~ 3.97, P < 0.001), smoking (OR = 2.04, 95% CI 1.16 ~ 3.59, P = 0.014), ostomy (OR = 1.65, 95% CI 1.04 ~ 2.61, P = 0.033), and chronic obstructive pulmonary disease (COPD) (OR = 2.23, 95% CI 1.09 ~ 4.57, P = 0.029) were independent risk factors. The light gradient boosting machine (LGBM) model displayed the largest area under the receiver operating characteristic curve (AUC) (0.74, 95% CI 0.68 ~ 0.81).In this study, VO was superior to BMI in evaluating the influence of obesity on metabolic comorbidities and postoperative infectious complications in colorectal cancer patients.© 2023. BioMed Central Ltd., part of Springer Nature.