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The liver DECT FF was determined by combining two regions of interest (ROI) in the right and one ROI in the left liver lobe (minimum area 3.6\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      ). The skeletal muscle index, muscle radiodensity attenuation, subcutaneous\/visceral adipose tissue area, and waist circumference were assessed. Pre-existing diseases, reasons for ICU admission, ICU scoring systems, and in-hospital mortality were noted.\n                      <jats:italic>t<\/jats:italic>\n                      -tests, Wilcoxon tests, linear or Cox regression, Pearson correlation, and intraclass correlation coefficients (ICC) were employed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 76 total patients, 43.4% were female (age 61\u2009\u00b1\u200912 years) and 97.4% received parenteral nutrition. In-hospital mortality was 60.8%. The liver DECT FF at CT1 was the only parameter associated with in-hospital mortality (hazard ratio: 1.15 [95% confidence interval: 1.07\u20131.24],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and a shorter ICU stay (\u22123.66 [\u22126.29 to \u22121.02] days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.007). DECT FF was not associated with ICU scoring systems. It did not relevantly change within a median of 8 days (3.3\u2009\u00b1\u20095.5% at CT1; 2.7\u2009\u00b1\u20094.3% at CT2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.315). Subset inter-observer reproducibility was good (ICC: 0.87 [0.66\u20130.95]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The liver DECT FF may serve as an independent prognostic imaging biomarker of mortality in critically ill patients, with a superior value to single-energy body composition parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Although the risk of liver steatosis is increased in critically ill patients, it is unknown if liver fat content, when quantified using DECT, is of prognostic value<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The liver DECT FF is associated with in-hospital mortality in critically ill patients<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The liver DECT FF may be superior for survival prognosis than single-energy CT body composition parameters of muscle and fat tissue at the ICU<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11851-3","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T17:33:47Z","timestamp":1754501627000},"page":"1341-1350","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dual-energy CT liver fat fraction as prognostic imaging biomarker in critically ill patients"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4855-7698","authenticated-orcid":false,"given":"Jennifer","family":"Erley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Breckow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Roedl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Kathrin","family":"Ozga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alidan","family":"Duoerkongjiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geraldine","family":"de Heer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Schubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Pallasch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Burdelski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Kluge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Yamamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerhard","family":"Adam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Molwitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"11851_CR1","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1007\/s00063-024-01157-5","volume":"119","author":"K Roedl","year":"2024","unstructured":"Roedl K, Fuhrmann V (2024) [Liver diseases in the intensive care unit]. 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Jennifer Erley, working at the University Medical Centre Hamburg-Eppendorf.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"One of the authors of this manuscript (JM) is an employee of GE HealthCare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Mrs. Ann-Kathrin Ozga and Mrs. Alidan Duoerkongjiang from the Institute of Medical Biometry and Epidemiology of the University Medical Centre Hamburg-Eppendorf kindly provided statistical advice for this manuscript and performed most statistical analyses.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was not required for this study because the study design was retrospective, and all CT exams were performed for clinical purposes.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained from the local ethics committee (\u00c4rztekammer Hamburg, PV7006-4406-BO-ff).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This is a follow-up project of a study previously published in\n                      European Radiology\n                      (doi: 10.1007\/s00330-024-10779-4), where we demonstrated the predictive value of muscular DECT FF in an overlapping patient cohort.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}