Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study.
Critical care outcomes
Electrophysiology
Muscle weakness
Paresis
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
05
11
2019
accepted:
08
01
2020
pubmed:
24
1
2020
medline:
28
4
2021
entrez:
24
1
2020
Statut:
ppublish
Résumé
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. 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). 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. 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.
Identifiants
pubmed: 31970446
doi: 10.1007/s00134-020-05927-5
pii: 10.1007/s00134-020-05927-5
doi:
Banques de données
ClinicalTrials.gov
['NCT00512122']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1184-1193Subventions
Organisme : Research Foundation Flanders
ID : G.0399.12
Pays : International
Organisme : Research Foundation Flanders
ID : 1805116N
Pays : International
Organisme : Research Foundation Flanders
ID : 1700111N
Pays : International
Organisme : Research Foundation Flanders
ID : 1131618N
Pays : International
Organisme : Methusalem program of the Flemish Government
ID : METH/08/07
Pays : International
Organisme : Methusalem program of the Flemish Government
ID : METH/14/06
Pays : International
Organisme : FP7 Ideas: European Research Council
ID : AdvG-2012-321670
Pays : International
Organisme : Horizon 2020 Framework Programme
ID : AdvG-2017-785809
Pays : International
Commentaires et corrections
Type : CommentIn
Type : CommentIn