title: Muscle Weakness and 5-Year Survival in Acute Respiratory Distress Syndrome Survivors.
abstract: OBJECTIVE
  To longitudinally evaluate the association of post-ICU muscle weakness and associated trajectories of weakness over time with 5-year survival.
  
  
  METHODS
  Longitudinal prospective cohort study over 5 years of follow-up.
  
  
  METHODS
  Thirteen ICUs in four hospitals in Baltimore, MD.
  
  
  METHODS
  One hundred fifty-six acute respiratory distress syndrome survivors.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: 1Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD. 3Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 4Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD. 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland, Baltimore, MD. 6Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.forename: Lisa
authors.initials: L
authors.lastname: Aronson Friedman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.forename: Carl B
authors.initials: CB
authors.lastname: Shanholtz
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Ciesla
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D010351:Patient Discharge; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors