Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study
Five-year impact of ICU-acquired neuromuscular complications: a prospective, observational study
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DOI：
10.1007/s00134-020-05927-5
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发表时间：
2020-01-22
影响因子：
38.9
通讯作者：
Hermans, Greet
中科院分区：
文献类型：
--
作者：
Van Aerde, Nathalie;Meersseman, Philippe;Hermans, Greet
目的评估ICU获得性神经肌肉并发症与5年死亡率和发病率之间的独立相关性。探讨医学研究理事会（MRC）总评分的最佳阈值，评估弱点，预测5年的结果。方法对一项前瞻性5年随访研究进行亚组分析，该研究包括883例EPaNIC患者（重症监护中的早期与晚期肠外营养）（Clinicaltrials.gov：NCT 00512122），在ICU中通过MRC总分（"MRC-队列"，N = 600）、第8天+/-1电生理学定量复合肌肉动作电位（"CMAP-队列"，N = 689）或两者（"MRC & CMAP-队列"，N = 415）系统筛查神经肌肉并发症。采用考克斯回归和线性回归分析ICU获得性神经肌肉并发症与5年死亡率、握力（HGF，%预测值）、6分钟步行距离（6-MWD，%预测值）和5年SF-36生活质量问卷（PF-SF-36）的身体功能之间的关系，并对混杂因素进行校正。通过鞅残差图（生存率）和散点图（发病率）确定ICU出院时MRC预测5年结局的最佳阈值。结果ICU出院时MRC总分较低，表明力量较弱[HR，每分增加：0.946（95% CI 0.928 - 0.968），p = 0.001]，CMAP异常，表明神经/肌肉功能障碍[HR：1.568（95% CI 1.165 - 2.186），p = 0.004]，与5年死亡率增加独立相关。在MRC和CMAP队列中，MRC [HR：0.956（95% CI 0.934 - 0.980），p = 0.001]而不是CMAP [HR：1.478（95% CI 0.875 - 2.838），p = 0.088]与5年死亡率独立相关。在205名存活者中，低MRC与低HGF独立相关[0.866（95% CI 0.237 - 1.527），p = 0.004]，低6-MWD [105.1（95% CI 12.1 - 212.9），p = 0.043]和低PF-SF-36 [-0.119（95% CI-0.186至-0.057），p = 0.002]，而异常CMAP与这些发病率终点无关。探索性分析表明，MRC
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