title: Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality.
abstract: OBJECTIVE
  To assess whether the presence and severity of intensive care unit-acquired paresis are associated with intensive care unit and in-hospital mortality.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Two medical, one surgical, and one medico-surgical intensive care units in two university hospitals and one university-affiliated hospital.
  
  
  METHODS
  A total of 115 consecutive patients were enrolled after > 7 days of mechanical ventilation.
  
  
  METHODS
  None.
  
  
  RESULTS
  The Medical Research Council score (from 0-60) was used to evaluate upper and lower limb strength at time of awakening, identified as the ability to follow five commands. Intensive care unit-acquired paresis was defined as a Medical Research Council score <48. Patients were followed-up until hospital discharge. The primary end point was hospital mortality. At awakening, median Medical Research Council score was 41 (interquartile range, 21-52), and 75 (65%) patients had intensive care unit-acquired paresis. Hospital non-survivors had a significantly lower Medical Research Council score at awakening (21 [11-43]) vs. 41 [28-53]; p = .008) and a significantly higher rate of intensive care unit-acquired paresis (85.1% vs. 58.4%; p = .02) compared to survivors. After multivariate risk adjustment, intensive care unit-acquired paresis was independently associated with higher hospital and intensive care unit mortality (odds ratio for hospital mortality, 2.02; 95% confidence interval, 1.03-8.03; p = .048). Each Medical Research Council point decrease was associated with a significantly higher hospital mortality (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; p = .033).
  
  
  CONCLUSIONS
  Both the presence and severity of intensive care unit-acquired paresis at the time of awakening are associated with increased intensive care unit and hospital mortality; the mechanisms underlying this association need further study.
authors.affiliation: Department of Intensive Care Medicine, Raymond Poincaré Hospital, University Versailles Saint-Quentin en Yvelines, Garches, France. tarek.sharshar@rpc.aphp.fr
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bastuji-Garin
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Durand
authors.forename: Isabelle
authors.initials: I
authors.lastname: Malissin
authors.forename: Pablo
authors.initials: P
authors.lastname: Rodriguez
authors.forename: Charles
authors.initials: C
authors.lastname: Cerf
authors.forename: Hervé
authors.initials: H
authors.lastname: Outin
authors.forename: Bernard
authors.initials: B
authors.lastname: De Jonghe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012720:Severity of Illness Index