Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study

Autor: Nathalie Van Aerde, Philippe Meersseman, Greet Van den Berghe, Frans Bruyninckx, Alexander Wilmer, Pieter Wouters, Jan Gunst, Rik Gosselink, Greet Hermans, Michael P Casaer, Yves Debaveye
Rok vydání: 2019
Předmět:
medicine.medical_specialty
Weakness
INTENSIVE-CARE-UNIT
Critical Care
Critical Illness
1-YEAR MORTALITY
Critical Care and Intensive Care Medicine
ACUTE LUNG INJURY
03 medical and health sciences
0302 clinical medicine
Critical Care Medicine
General & Internal Medicine
Critical care outcomes
POLYNEUROMYOPATHY
Internal medicine
Intensive care
Anesthesiology
Medicine
Humans
Prospective Studies
Critical Care Outcomes
DISCHARGE
Paresis
SURVIVORS
OUTCOMES
Science & Technology
Muscle Weakness
business.industry
Proportional hazards model
Confounding
Muscle weakness
030208 emergency & critical care medicine
RECOVERY
3. Good health
Electrophysiology
Intensive Care Units
030228 respiratory system
SKELETAL-MUSCLE WEAKNESS
CRITICAL ILLNESS MYOPATHY
medicine.symptom
business
Life Sciences & Biomedicine
Follow-Up Studies
Zdroj: Intensive Care Medicine
ISSN: 1432-1238
Popis: PURPOSE: To assess the independent association between ICU-acquired neuromuscular complications and 5-year mortality and morbidity. To explore the optimal threshold of the Medical Research Council (MRC) sum score, assessing weakness, for the prediction of 5-year outcomes. METHODS: Sub-analyses of a prospective, 5-year follow-up study including 883 EPaNIC patients (Early versus Late Parenteral Nutrition in Intensive Care) (Clinicaltrials.gov:NCT00512122), systematically screened in ICU for neuromuscular complications with MRC sum score ('MRC-cohort', N = 600), electrophysiology on day 8 ± 1 to quantify compound muscle action potential ('CMAP-cohort', N = 689), or both ('MRC&CMAP-cohort', N = 415). Associations between ICU-acquired neuromuscular complications and 5-year mortality, hand-grip strength (HGF, %predicted), 6-min-walk distance (6-MWD, %predicted) and physical function of the SF-36 quality-of-life questionnaire (PF-SF-36) at 5-years were assessed with Cox regression and linear regression, adjusted for confounders. The optimal threshold for MRC at ICU discharge to predict 5-year outcomes was determined by martingale residual plots (survival) and scatterplots (morbidity). RESULTS: Both lower MRC sum score at ICU discharge, indicating less strength [HR, per-point-increase: 0.946 (95% CI 0.928-0.968), p = 0.001], and abnormal CMAP, indicating nerve/muscle dysfunction [HR: 1.568 (95% CI 1.165-2.186), p = 0.004], independently associated with increased 5-year mortality. In the MRC&CMAP-cohort, MRC [HR: 0.956 (95% CI 0.934-0.980), p = 0.001] but not CMAP [HR: 1.478 (95% CI 0.875-2.838), p = 0.088] independently associated with 5-year mortality. Among 205 survivors, low MRC independently associated with low HGF [0.866 (95% CI 0.237-1.527), p = 0.004], low 6-MWD [105.1 (95% CI 12.1-212.9), p = 0.043] and low PF-SF-36 [- 0.119 (95% CI - 0.186 to - 0.057), p = 0.002], whereas abnormal CMAP did not correlate with these morbidity endpoints. Exploratory analyses suggested that MRC ≤ 55 best predicted poor long-term morbidity and mortality. Both MRC ≤ 55 and abnormal CMAP independently associated with 5-year mortality. CONCLUSIONS: ICU-acquired neuromuscular complications may impact 5-year morbidity and mortality. MRC sum score, even if slightly reduced, may affect long-term mortality, strength, functional capacity and physical function, whereas abnormal CMAP only related to long-term mortality. ispartof: INTENSIVE CARE MEDICINE vol:46 issue:6 pages:1184-1193 ispartof: location:United States status: published
Databáze: OpenAIRE
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