Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors
Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors
复制标题
DOI：
10.1097/ccm.0000000000002208
复制
发表时间：
2017-03-01
影响因子：
8.8
通讯作者：
Needham, Dale M.
中科院分区：
文献类型：
--
作者：
Dinglas, Victor D.;Friedman, Lisa Aronson;Needham, Dale M.
目的：纵向评估icu后肌无力和肌无力相关轨迹与5年生存率的关系。设计：纵向前瞻性队列研究，随访5年以上。环境：马里兰州巴尔的摩市四家医院的13个icu。患者：156名急性呼吸窘迫综合征幸存者。干预措施:没有。测量和主要结果：力量采用标准化手工肌肉测试评估，使用医学研究委员会的总评分（范围0-60，越高越好），icu后虚弱定义为总评分小于48。在出院时以及急性呼吸窘迫综合征后3、6、12、24、36和48个月时评估肌肉力量。出院时，38%的患者有肌肉无力。出院时总评分每增加1分与生存率提高相关（风险比[95% CI]， 0.96[0.94-0.98]），纵向结果相似（0.95[0.93-0.98]）。出院时虚弱与较差的5年生存率相关（1.75[1.01-3.03]），但在随访中纵向评估时，相关性减弱（1.54[0.82-2.89]）。在随访期间，50%的患者存在肌无力的持续和消退轨迹，与没有肌无力的患者相比，其生存率更差（分别为3.01[1.12-8.04]和3.14[1.40-7.03]）。结论：出院时，超过三分之一的急性呼吸窘迫综合征幸存者有肌肉无力。出院时和随访期间更大的强度与5年生存率的提高有关。在ICU后虚弱的患者中，持续和消退的轨迹都是常见的，并且在随访期间与较差的生存率相关。
Objectives: To longitudinally evaluate the association of post-ICU muscle weakness and associated trajectories of weakness over time with 5-year survival.Design: Longitudinal prospective cohort study over 5 years of follow-up.Setting: Thirteen ICUs in four hospitals in Baltimore, MD.Patients: One hundred fifty-six acute respiratory distress syndrome survivors. Interventions: None.Measurements and Main Results: Strength was evaluated with standardized manual muscle testing using the Medical Research Council sum score (range, 0-60; higher is better), with post-ICU weakness defined as sum score less than 48. Muscle strength was assessed at hospital discharge and at 3, 6, 12, 24, 36, and 48 months after acute respiratory distress syndrome. At discharge, 38% of patients had muscle weakness. Every one point increase in sum score at discharge was associated with improved survival (hazard ratio [95% CI], 0.96 [0.94-0.98]), with similar findings longitudinally (0.95 [0.93-0.98]). Having weakness at discharge was associated with worse 5-year survival (1.75 [1.01-3.03]), but the association was attenuated (1.54 [0.82-2.89]) when evaluated longitudinally over follow-up. Persisting and resolving trajectories of muscle weakness, occurring in 50% of patients during follow-up, were associated with worse survival (3.01 [1.12-8.04]; and 3.14 [1.40-7.03], respectively) compared to a trajectory of maintaining no muscle weakness.Conclusions: At hospital discharge, greater than one third of acute respiratory distress syndrome survivors had muscle weakness. Greater strength at discharge and throughout follow-up was associated with improved 5-year survival. In patients with post ICU weakness, both persisting and resolving trajectories were commonly experienced and associated with worse survival during follow-up.