Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis.
BACKGROUND
Intensive care unit (ICU)-acquired weakness is a frequent complication of critical illness. It is unclear whether it is a marker or mediator of poor outcomes.


OBJECTIVE
To determine acute outcomes, 1-year mortality, and costs of ICU-acquired weakness among long-stay (≥8 d) ICU patients and to assess the impact of recovery of weakness at ICU discharge.


METHODS
Data were prospectively collected during a randomized controlled trial. Impact of weakness on outcomes and costs was analyzed with a one-to-one propensity-score-matching for baseline characteristics, illness severity, and risk factor exposure before assessment. Among weak patients, impact of persistent weakness at ICU discharge on risk of death after 1 year was examined with multivariable Cox proportional hazards analysis.


RESULTS
A total of 78.6% were admitted to the surgical ICU; 227 of 415 (55%) long-stay assessable ICU patients were weak; 122 weak patients were matched to 122 not-weak patients. As compared with matched not-weak patients, weak patients had a lower likelihood for live weaning from mechanical ventilation (hazard ratio [HR], 0.709 [0.549-0.888]; P = 0.009), live ICU (HR, 0.698 [0.553-0.861]; P = 0.008) and hospital discharge (HR, 0.680 [0.514-0.871]; P = 0.007). In-hospital costs per patient (+30.5%, +5,443 Euro per patient; P = 0.04) and 1-year mortality (30.6% vs. 17.2%; P = 0.015) were also higher. The 105 of 227 (46%) weak patients not matchable to not-weak patients had even worse prognosis and higher costs. The 1-year risk of death was further increased if weakness persisted and was more severe as compared with recovery of weakness at ICU discharge (P < 0.001).


CONCLUSIONS
After careful matching the data suggest that ICU-acquired weakness worsens acute morbidity and increases healthcare-related costs and 1-year mortality. Persistence and severity of weakness at ICU discharge further increased 1-year mortality. Clinical trial registered with www.clinicaltrials.gov (NCT 00512122).
1 Medical Intensive Care Unit, Department of General Internal Medicine, and.
Greet
G
Hermans
Helena
H
Van Mechelen
Beatrix
B
Clerckx
Tine
T
Vanhullebusch
Dieter
D
Mesotten
Alexander
A
Wilmer
Michael P
MP
Casaer
Philippe
P
Meersseman
Yves
Y
Debaveye
Sophie
S
Van Cromphaut
Pieter J
PJ
Wouters
Rik
R
Gosselink
Greet
G
Van den Berghe
D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000191:economics / Q000534:rehabilitation; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000191:economics / Q000401:mortality* / Q000534:rehabilitation; D063868:Patient Outcome Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index
costs and cost analysis; critical illness; mortality; muscle strength; muscle weakness