Published ahead of print on May 29, 2008, doi:10.1164/rccm.200712-1829OC Am. J. Respir. Crit. Care Med., Volume 178, Number 3, August 2008, 261-268 A more recent version of this article appeared on August 1, 2008
Submitted on December 14, 2007 Acquired Weakness, Handgrip Strength and Mortality in Critically Ill PatientsNaeem A Ali1*,1 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, The Ohio State University, Columbus, OH, USA, 2 Department of Internal Medicine, Center for Biostatistics, The Ohio State University, Columbus, OH, USA, 3 Division of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada, 4 Division of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, Cleveland, OH, USA, 5 Division of Pulmonary, Critical Care and Sleep Medicine, The Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA, 6 Division of Pulmonary and Critical Care Medicine, The Department of Internal Medicine, University Hospitals Case Medical Center, Case-Western Reserve University, Cleveland, OH, USA, 7 The Department of Internal Medicine, Indiana University Medical Center, Indianapolis, IN, USA, 8 The College of Public Health, The Ohio State University, Columbus, OH, USA, 9 Division of Pulmonary, Critical Care and Sleep Medicine, The Department of Internal Medicine, MetroHealth Medical Center, Cleveland, OH, USA * To whom correspondence should be addressed. E-mail: naeem.ali{at}osumc.edu.
Rationale: ICU-acquired paresis (ICUAP) is common in survivors of critical illness. There is significant associated morbidity, including prolonged time on the ventilator and longer hospital stay. However, it is unclear if ICUAP is independently associated with mortality since sicker patients are more prone and existing studies have not adjusted for this. Objective: To test the hypothesis that ICUAP is independently associated with increased mortality. Secondarily, to determine if handgrip dynamometry is a concise measure of global strength and is independently associated with mortality. Methods: A prospective multicenter cohort study was conducted in intensive care units (ICU) of five academic medical centers. Adults requiring at least five days of mechanical ventilation without evidence of preexisting neuromuscular disease were followed until awakening and were then examined for global and handgrip strength. Measurement(s): Global strength and handgrip dynamometry. The primary outcome was in-hospital mortality and secondary outcomes were hospital and ICU-free days, ICU readmission and recurrent respiratory failure. Main results: Subjects with ICUAP (average MRC score of <4) had longer hospital stays and required mechanical ventilation longer. Handgrip strength was lower in subjects with ICUAP and had good test-performance for diagnosing ICUAP. After adjustment for severity of illness, ICUAP was independently associated with hospital mortality (OR 7.8, 95%CI 2.4-25.3, p=0.001).Separately, handgrip strength was independently associated with hospital mortality (OR 4.5, 95%CI 1.5-13.6, p=0.007). Conclusions: ICUAP is independently associated with increased hospital mortality. Handgrip strength is also independently associated with poor hospital outcome and may serve as a simple test to identify ICUAP. Clinical Trials Registry Information: ID# NCT00106665 registered at www.clinicaltrials.gov Key words: Polyneuropathy, Critical Illness; muscle weakness, hand strength
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