Causes of Mortality in ICU-Acquired Weakness

Risk factors for ICU-acquired weakness in sepsis patients: A retrospective study of 264 patients

Background

Sepsis is a common critical illness in intensive care unit (ICU) and an important risk factor for intensive care unit-acquired weakness (ICU-AW). The objective of the study is to analyze the risk factors of ICU-AW in septic patients.

Methods

A total of 264 septic patients admitted to the General Hospital of the Western Theater Command from January 2018 to April 2022 were included in this study. The cohort was divided into 2 groups according to the presence or absence of ICU-AW. Clinical characteristics included age, sex, body mass index, length of ICU stay, multiple organ dysfunction syndrome, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), mechanical ventilation time, intubation, tracheotomy, protective constraint, lactic acid, fasting blood glucose, etc. The clinical characteristics of sepsis were evaluated using logistic regression analysis.

Results

A total of 114 septic patients suffered ICU-AW during their ICU stay. Multivariate binary logistic regression analysis showed that APACHE Ⅱ score, mechanical ventilation time, protective constraint, and lactic acid were independent risk factors for ICU-AW in septic patients. The areas under the receiver operating characteristic curve (AUCs) were 0.791, 0.740 and 0.812, all P < 0.05, and the optimal cut-off values were 24 points, 5 days and 2.12 mmol/L, respectively.

Conclusions

A high APACHE Ⅱ score, long mechanical ventilation time, protective constraint and high lactate concentration are independent risk factors for ICU-AW in septic patients. An APACHE Ⅱ score greater than 24 points, mechanical ventilation time longer than 5 days and lactate concentration higher than 2.12 mmol/L are likely to cause ICU-AW.

Significant risk factors for intensive care unit-acquired weakness: A processing strategy based on repeated machine learning

BACKGROUND

Intensive care unit-acquired weakness (ICU-AW) is a common complication that significantly impacts the patient's recovery process, even leading to adverse outcomes. Currently, there is a lack of effective preventive measures.

AIM

To identify significant risk factors for ICU-AW through iterative machine learning techniques and offer recommendations for its prevention and treatment.

METHODS

Patients were categorized into ICU-AW and non-ICU-AW groups on the 14th day post-ICU admission. Relevant data from the initial 14 d of ICU stay, such as age, comorbidities, sedative dosage, vasopressor dosage, duration of mechanical ventilation, length of ICU stay, and rehabilitation therapy, were gathered. The relationships between these variables and ICU-AW were examined. Utilizing iterative machine learning techniques, a multilayer perceptron neural network model was developed, and its predictive performance for ICU-AW was assessed using the receiver operating characteristic curve.

RESULTS

Within the ICU-AW group, age, duration of mechanical ventilation, lorazepam dosage, adrenaline dosage, and length of ICU stay were significantly higher than in the non-ICU-AW group. Additionally, sepsis, multiple organ dysfunction syndrome, hypoalbuminemia, acute heart failure, respiratory failure, acute kidney injury, anemia, stress-related gastrointestinal bleeding, shock, hypertension, coronary artery disease, malignant tumors, and rehabilitation therapy ratios were significantly higher in the ICU-AW group, demonstrating statistical significance. The most influential factors contributing to ICU-AW were identified as the length of ICU stay (100.0%) and the duration of mechanical ventilation (54.9%). The neural network model predicted ICU-AW with an area under the curve of 0.941, sensitivity of 92.2%, and specificity of 82.7%.

CONCLUSION

The main factors influencing ICU-AW are the length of ICU stay and the duration of mechanical ventilation. A primary preventive strategy, when feasible, involves minimizing both ICU stay and mechanical ventilation duration.

Construction and evaluation of acquired weakness nomogram model in patients with mechanical ventilation in intensive care unit

Objective

The incidence of intensive care unit acquired weakness (ICU-AW) has shown an increasing trend with still a lack of effective treatment options. The early assessment of the risk of developing ICU-AW can provide patients with targeted interventions. This study aimed to determine the independent risk factors of ICU-AW in patients receiving mechanical ventilation (MV) and develop a nomogram and verify its predictive efficacy.

Methods

This observational study included patients receiving MV therapy in the ICU of our hospital between January 2020 and January 2023. They were divided into the ICU-AW and non-ICU-AW groups. The training cohort (n = 264) and the validation cohort (n = 143) were constructed. Multivariate logistic regression analyses were used to select the risk factors, and a nomogram model was established. Calibration, receiver operating characteristic (ROC), and decision curves were used to evaluate the effectiveness of the model.

Results

The MV duration (OR = 1.24, 95%CI[1.11, 1.38]), APACHE II score (OR = 1.34, 95%CI[1.20, 1.50]), SOFA score (OR = 1.36, 95%CI[1.21, 1.53]), age (OR = 1.05, 95%CI[1.00, 1.10]), nerve blockers (OR = 3.26, 95%CI[1.34, 7.92]), and diabetes mellitus (OR = 3.12, 95%CI[1.10, 8.87]) were independent risk factors for ICU-AW. The nomogram had good predictive efficacy for both the training (area under the curve (AUC) = 0.950, 95%CI [0.93, 0.97]) and validation cohorts (AUC = 0.823, 95%CI [0.75, 0.89]).

Conclusion

The MV duration, APACHE II, SOFA, age, use of nerve blockers, and diabetes mellitus are independent risk factors for ICU-AW. The nomogram model based on them had good predictive efficacy and may be clinically useful.

Quantification of muscle tone by using shear wave velocity during an anaesthetic induction: a prospective observational study

OBJECTIVES

The quantitative assessment of muscle stiffness or weakness is essential for medical care. Shear wave elastography is non-invasive ultrasound method and provides quantitative information on the elasticity of soft tissue. However, the universal velocity scale for quantification has not been developed. The aim of the study is to determine the shear wave velocities of abdominal muscle during anesthetic induction and to identify methods to cancel the effects of confounders for future development in the quantitative assessment of muscle tone using the universal scale.

METHODS

We enrolled 75 adult patients undergoing elective surgery with ASA-PS I - III in the period between December 2018 and March 2021. We measured and calculated the shear wave velocity (SWV) before and after opioid administration (i.e., the baseline at rest and opioid-induced rigidity condition), and after muscle relaxant administration (i.e., zero reference condition). The SWV value was adjusted for the subcutaneous fat thickness by our proposed corrections. The SWVs after the adjustment were compared among the values in baseline, rigidity, and relaxation using one-way repeated-measures ANOVA and post hoc Tukey-Kramer test. A p-value of < 0.05 was considered to be statistically significant. UMIN Clinical Trials Registry identifier UMIN000034692, registered on October 30, 2018.

RESULTS

The SWVs in the baseline, opioid-induced rigidity, and muscle relaxation conditions after the adjustment were 2.08 ± 0.48, 2.41 ± 0.60, and 1.79 ± 0.30 m/s, respectively (p < 0.001 at all comparisons).

CONCLUSION

The present study suggested that the SWV as reference was 1.79 m/s and that the SWVs at rest and opioid-induced rigidity were ~ 10% and ~ 30% increase from the reference, respectively. The SWV adjusted for the subcutaneous fat thickness may be scale points for the assessment of muscle tone.

Incidence of hypoxic hepatitis in patients with cardiogenic shock and association with mortality

AIMS

Shock of any cause leads to end-organ damage due to ischaemia, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis (S-HH) is defined as the 20-fold increase of the upper normal limit of aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) and is associated with a mortality of up to 60%. However, as pathophysiology, dynamics, and treatment differ between septic and cardiogenic shock (CS), the S-HH definition may not be suitable for CS. Therefore, we aim to evaluate if the S-HH definition is applicable in CS patients.

METHODS AND RESULTS

This analysis was based on a registry of all-comer CS patients treated between 2009 and 2019 at a tertiary care centre with exclusion of minors and patients without all necessary ASAT and ALAT values. N = 698. During in-hospital follow-up, 386 (55.3%) patients died. The S-HH was not significantly associated with in-hospital mortality in CS patients. To define HH among patients with CS (C-HH), optimal cut-off values were found to be ≥1.34-fold increase for ASAT and ≥1.51-fold increase for ALAT in serial measurements. The incidence of C-HH was 254/698 patients (36%) and C-HH showed a strong association with in-hospital mortality (odds ratio 2.36, 95% confidence interval: 1.61, 3.49).

CONCLUSION

The C-HH is a frequent and relevant comorbidity in patients with CS, although its definition varies from the established definition of HH in patients with septic shock. As C-HH contributed to excess mortality risk, these findings emphasize the need for further investigation of therapies reducing the occurrence of C-HH and also improving the associated outcome.

Effect of Optimizing Medical Rehabilitation System for Patients with Coronavirus Disease 2019 Using the Functional Resonance Analysis Method

Objectives

Coronavirus infection 2019 (COVID-19) is an indication for rehabilitation medicine, especially in severe cases. However, there has been no system analysis of safe and continuous provision of medical rehabilitation for COVID-19 patients. The aim of this study was to confirm the effectiveness of rehabilitation for severe COVID-19 and to analyze the optimization of the medical rehabilitation system using the Functional Resonance Analysis Method (FRAM).

Methods

The subject of the analysis was the medical rehabilitation system itself, which had been implemented by the Rehabilitation Center of our hospital in response to the increased number of COVID-19 patients. In the FRAM analysis, Functions were identified, and their relationships were examined. Functions were established using a hierarchical cross-check by the authors. Patient outcomes resulting from optimization of the rehabilitation system were length of hospital stay, patient independence in daily living, and rehabilitation-related medical costs, and these were statistically validated.

Results

In repeated optimizations of the rehabilitation system, the main issues were "handling of infected patients and isolation of usual clinical practice," "staff rotation," and "remote consultation". The modification of the medical rehabilitation system was associated with shorter hospital stays, shorter periods of time without prescription, faster improvement in independence of daily living, and lower rehabilitation-related medical costs.

Conclusions

Optimization at each stage of medical rehabilitation resulted in positive effects on patient outcomes. FRAM is useful for identifying and the optimization of key functions.

Knowledge, attitudes and practices regarding children with ICU-acquired weakness in pediatric intensive care unit among chinese medical staff: a cross-sectional survey

BACKGROUND

ICU-AW (Intensive Care Unit Acquired Weakness) is characterized by significant muscle weakness and can be caused by a variety of factors, including immobility, medication use, and underlying medical conditions.ICU-AW can affect critically ill children who have been hospitalized in the PICU for an extended period of time.The knowledge, attitude and practice level of ICU-AW of PICU medical staff directly affect the treatment of critically ill children with ICU-AW.The aim to this study was to explore the knowledge, attitudes, and practices of Chinese medical staff regarding critically ill children with intensive care unit-acquired weakness (ICU-AW) and related factors.

METHODS

A Knowledge, Attitudes, and Practices (KAP) Questionnaire regarding critically ill children with ICU-AW was distributed to a stratified sample of 530 pediatric intensive care unit (PICU) healthcare workers. The questionnaire consisted of 31 items-with scores of 45, 40, and 40 for each dimension and a total score of 125.

RESULTS

The mean total score of Chinese PICU healthcare workers for the KAP questionnaire regarding children with ICU-AW was 87.36 ± 14.241 (53-121), with mean total knowledge, attitudes, and practices scores of 30.35 ± 6.317, 30.46 ± 5.632, and 26.54 ± 6.454, respectively. The population distribution indicated that 50.56%, 46.04%, and 3.4% of healthcare workers had poor, average, and good scores, respectively. Multiple linear regression showed that gender, education, and hospital level classification influenced the KAP level of PICU healthcare workers regarding critically ill children with ICU-AW.

CONCLUSIONS

Overall, PICU healthcare workers in China have an average KAP level about ICU-AW, and the gender and education level of PICU healthcare workers, as well as the classification of hospitals where they work, predict the KAP status of healthcare workers regarding children with ICU-AW. Therefore, healthcare leaders should plan and develop specific training programs to improve the KAP level of PICU healthcare workers.

The association of oral health with length of stay and mortality in the intensive care unit

OBJECTIVES

To analyze the relationship between the oral and systemic health status of adult patients admitted to the intensive care unit (ICU) with the length of stay and mortality.

MATERIAL AND METHODS

A daily oral examination and oral hygiene were performed in patients admitted to an adult ICU. Dental and oral lesions, systemic health status, the need for mechanical ventilation, length of stay, and mortality were registered. Multivariate linear and logistic regression analyses were performed to identify associations between length of stay and death of patients, respectively, with oral and systemic health status.

RESULTS

In total, 207 patients were included, 107 (51.7%) male. Ventilated patients presented an increased length of stay (p < 0.001), mortality (p < 0.0001), number of medications (p < 0.0001), edentulism (p = 0.001), mucous lesions and bleeding (p < 0.0001), oropharyngitis (p = 0.03), and drooling (p < 0.001) compared to non-ventilated patients. The number of days in the ICU was associated with mechanical ventilation (p = 0.04), nosocomial pneumonia (p = 0001), end-stage renal disease (p < 0.0007), death (p < 0.0001), mucous bleeding (p = 0.01), tongue coating (p = 0.001), and cheilitis (p = 0.01). Mortality was associated with length of stay in the ICU (p < 0.0001), number of medications (p < 0.0001), and the need for mechanical ventilation (p = 0.006).

CONCLUSION

ICU patients present poor oral health. Soft tissue biofilm and mucous ulcerations were associated with the length of stay in the ICU, but not with the mortality rate.

CLINICAL RELEVANCE

Mucous lesions are associated with an increased length of stay in the ICU, and critically ill patients should receive oral care to control oral foci of infection and mucous lesions.

Blockade of Indoleamine 2,3-Dioxygenase attenuates lipopolysaccharide-induced kidney injury by inhibiting TLR4/NF-κB signaling

Blockade of indoleamine 2,3-dioxygenase (IDO) has been shown to alleviate lipopolysaccharide (LPS)-induced endotoxic shock and reduce sepsis mortality, but its effect on LPS-induced kidney damage has not been reported. Herein, we established a mouse kidney injury model by intraperitoneal injection of 10 mg/kg LPS and established an in vitro renal tubular epithelial cell injury model by stimulating TCMK-1 cells with 10 mg/L LPS. We found that pretreatment with 1-methyl tryptophan (1-MT), an IDO inhibitor, significantly improved LPS-induced mouse survival, and IDO knockout (KO) mice also had higher survival rates after LPS exposure than wild-type mice. At the same time, IDO KO or pretreatment with 1-MT not only reduced serum creatinine, blood urea nitrogen, renal tubular injury pathological score, but also inflammatory factors and oxidative stress status in serum or kidney of LPS-exposed mice. In vitro, blockade of IDO with 1-MT significantly inhibited LPS-induced apoptosis, inflammation and oxidative stress in TCMK-1 cells. In addition, blockade of IDO significantly inhibited LPS-activated TLR4/NF-κB signaling pathway in kidney of mice or in TCMK-1 cells. In conclusion, our results suggested that blockade of IDO attenuated kidney inflammation, apoptosis and oxidative stress to protect against LPS-induced septic kidney injury via inhibiting the TLR4/NF-κB signaling pathway.

Development and validation of an intensive care unit acquired weakness prediction model: A cohort study

Background

At present, intensive care unit acquired weakness (ICU-AW) has become an important health care issue. The aim of this study was to develop and validate an ICU-AW prediction model for adult patients in intensive care unit (ICU) to provide a practical tool for early clinical diagnosis.

Methods

An observational cohort study was conducted including 400 adult patients admitted from September 2021 to June 2022 at an ICU with four ward at a medical university affiliated hospital in China. The Medical Research Council (MRC) scale was used to assess bedside muscle strength in ICU patients as a diagnostic basis for ICUAW. Patients were divided into the ICU-AW group and the no ICU-AW group and the clinical data of the two groups were statistically analyzed. A risk prediction model was then developed using binary logistic regression. Sensitivity, specificity, and the area under the curve (AUC) were used to evaluate the predictive ability of the model. The Hosmer-Lemeshow test was used to assess the model fit. The bootstrap method was used for internal verification of the model. In addition, the data of 120 patients in the validation group were selected for external validation of the model.

Results

The prediction model contained five risk factors: gender (OR: 4.31, 95% CI: 1.682-11.042), shock (OR: 3.473, 95% CI: 1.191-10.122), mechanical ventilation time (OR: 1.592, 95% CI: 1.317-1.925), length of ICU stay (OR: 1.085, 95% CI: 1.018-1.156) and age (OR: 1.075, 95% CI: 1.036-1.115). The AUC of this model was 0.904 (95% CI: 0.847-0.961), with sensitivity of 87.5%, specificity of 85.8%, and Youden index of 0.733. The AUC of the model after resampling is 0.889. The model verification results showed that the sensitivity, specificity and accuracy were 71.4, 92.9, and 92.9%, respectively.

Conclusion

An accurate, and readily implementable, risk prediction model for ICU-AW has been developed. This model uses readily obtained variables to predict patient ICU-AW risk. This model provides a tool for early clinical screening for ICU-AW.

Prediction of septic and hypovolemic shock in intensive care unit patients using machine learning

OBJECTIVE

To create and validate a model for predicting septic or hypovolemic shock from easily obtainable variables collected from patients at admission to an intensive care unit.

METHODS

A predictive modeling study with concurrent cohort data was conducted in a hospital in the interior of northeastern Brazil. Patients aged 18 years or older who were not using vasoactive drugs on the day of admission and were hospitalized from November 2020 to July 2021 were included. The Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost classification algorithms were tested for use in building the model. The validation method used was k-fold cross validation. The evaluation metrics used were recall, precision and area under the Receiver Operating Characteristic curve.

RESULTS

A total of 720 patients were used to create and validate the model. The models showed high predictive capacity with areas under the Receiver Operating Characteristic curve of 0.979; 0.999; 0.980; 0.998 and 1.00 for the Decision Tree, Random Forest, AdaBoost, Gradient Boosting and XGBoost algorithms, respectively.

CONCLUSION

The predictive model created and validated showed a high ability to predict septic and hypovolemic shock from the time of admission of patients to the intensive care unit.

Exploring the Muscle Metabolomics in the Mouse Model of Sepsis-Induced Acquired Weakness

Background/Aim

We aimed to identify the differentially expressing metabolites (DEMs) in the muscles of the mouse model of sepsis-induced acquired weakness (sepsis-AW) using liquid chromatography-mass spectrometry (LC-MS).

Materials and Methods

Sepsis by cecal ligation puncture (CLP) with lower limb immobilization was used to produce a sepsis-AW model. After this, the grip strength of the C57BL/6 male mice was investigated. The transmission electron microscopy was utilized to determine the pathological model. LC-MS was used to detect the metabolic profiles within the mouse muscles. Additionally, a statistically diversified analysis was carried out.

Results

Compared to the sepsis group, 30 DEMs, including 17 upregulated and 13 down-regulated metabolites, were found in the sepsis-AW group. The enriched metabolic pathways including purine metabolism, valine/leucine/isoleucine biosynthesis, cGMP-PKG pathway, mTOR pathway, FoxO pathway, and PI3K-Akt pathway were found to differ between the two groups. The targeted metabolomics analysis explored significant differences between four amino acid metabolites (leucine, cysteine, tyrosine, and serine) and two energy metabolites (AMP and cAMP) in the muscles of the sepsis-AW experimental model group, which was comparable to the sepsis group.

Conclusion

The present work identified DEMs and metabolism-related pathways within the muscles of the sepsis-AW mice, which offered valuable experimental data for diagnosis and identification of the pathogenic mechanism underlying sepsis-AW.

Safety of arterial catheterization using the distal radial approach in intensive care unit management: A pilot study

BACKGROUND

Arterial catheter (A-line) is essential for managing severely ill patients, and the radial artery is the most common insertion site in the intensive care unit (ICU). However, many accidental removals occur because the insertion site of A-line in the traditional radial approach (TRA) overlaps with the joint flexion. Recent reports have shown no significant difference in the complication rates between coronarography using the distal radial approach (DRA) and that using TRA. However, to date, no report has examined accidental removals of DRA in the ICU. This study aimed to retrospectively evaluate the safety of the DRA A-line in ICU management.

METHODS

This retrospective, descriptive, and observational study enrolled patients who underwent A-line insertion using the DRA at the authors' facility, which is a university hospital with approximately 1100 beds, from January 1, 2019 to August 31, 2019. The participants' clinical data were extracted from their medical records. The primary outcome was the number of accidental removals.

RESULTS

The study included 20 patients with a median age of 70 (interquartile range (IQR): 58.5-77) years: 10 patients with traumas, 6 with cerebral hemorrhages, 2 with gastrointestinal perforations, and 2 with other diagnoses. The number of punctures was 1 in 15 patients, 2 in 4 patients, and 3 in 1 patient. Only 1 patient required ultrasound guidance, whereas 12 patients required the use of guidewires. The median duration after insertion was 3 (IQR 2.5-5.5) days. Accidental removal was noted in only one patient. No other complications were observed during the period from insertion to removal.

CONCLUSIONS

DRA may be a safe option for insertion of a new A-line in the ICU.

Post-intensive care syndrome as a predictor of mortality in patients with critical illness: A cohort study

Introduction

The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness.

Materials and methods

In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality.

Results

Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623).

Conclusion

While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.

Current practice and barriers to ICU-acquired weakness assessment: a cross-sectional survey

BACKGROUND

Intensive-care-unit-acquired weakness (ICU-AW) not only leads to difficulty weaning off mechanical ventilation, prolonged hospital stay and increased medical costs, but also reduces the patient's quality of life after discharge and increases the 1-year mortality rate. Early identification and intervention can improve the prognosis of critically ill patients. However, much remains unknown about current clinical practice for ICU-AW assessment by ICU staff in China.

OBJECTIVES

To investigate current practices and barriers to ICU-AW assessment among ICU staff, and provide insights to improve ICU-AW assessment in ICUs in China.

METHODS

Qualitative interviews were used to construct a survey questionnaire (test-retest reliability 0.92, validity 0.96). This survey was subsequently completed by 3206 ICU staff from 31 provinces, municipalities and autonomous regions in China.

RESULTS

In total, 3206 ICU staff responded to the survey (response rate 90%): 616 doctors (19%), 2371 nurses (74%), 129 respiratory therapists (4%), 51 physiotherapists (2%) and 39 dieticians (1%). Only 27% of the respondents had treated/cared for patients with ICU-AW. Reported methods for ICU-AW assessment were clinical experience (53%), ICU-AW assessment tools (12%), and physiotherapy consultation (35%). Forty-three percent of respondents felt that their ICU-AW-related knowledge did not meet clinical needs, only 10% had received ICU-AW-related training, and 19% proactively assessed whether their patients had ICU-AW. In terms of frequency of assessment, 42%, 16% and 11% of respondents considered that ICU-AW should be assessed daily, every 3 days, and on ICU admission and discharge, respectively. The Medical Research Council scale, electrophysiological assessment and the Manual Muscle Testing scale were considered to be optimal tools for ICU-AW diagnosis by 79%, 70%, and 73% of respondents, respectively. The main reported barriers to ICU-AW assessment were lack of knowledge, cognitive impairment among patients, and lack of ICU-AW assessment guidelines and procedures.

CONCLUSION

Current practices for ICU-AW assessment are non-specific, and the main barriers include lack of skills and knowledge.

Ultrasound Measurement of Septic Shock-induced Acute Skeletal Muscle Atrophy in Intensive Care Unit

BACKGROUND

Skeletal muscle wasting progresses rapidly during critical care. However, the effect of skeletal muscle changes on physical function during intensive care remain poorly understood.

OBJECTIVE

To examine the changes in skeletal muscle thickness of patients admitted to the intensive care unit (ICU) for septic shock and the relationship between skeletal muscle thickness and physical function following intensive care.

DESIGN

Longitudinal observational study.

SETTING

Single emergency hospital.

PATIENTS

Ten septic shock patients who were mechanically ventilated in the ICU were recruited.

INTERVENTIONS

Not applicable.

METHODS

Ultrasound measurements of thickness of rectus femoris (RF) were conducted within 24 hours after admission and repeated every two days until the 14th hospital day. The correlations between TRF and various parametric data (i.e., age, severity classification, mechanically ventilated period, length of stay (LOS) at the ICU, and physical function) correlations were assessed with Pearson's product moment coefficient of correlation.

MAIN OUTCOME MEASURE(S)

Curve estimation for best fit for chronological changes in TRF with respect to the HD and the correlation between TRF and clinical indicators.

RESULTS

Eight septic shock patients were observed completely for 14 days. TRF decreased linearly by 30.6% (IQR: 23.9-45.7) during the first 14 days. The correlation between TRF at admission and physical function at the 30th hospital day was close to significant. The TRF at the 14th hospital day was negatively correlated with disease severity and age. A positive correlation was observed between the decrease in rate of TRF and LOS at the ICU.

CONCLUSION

Skeletal muscle thickness of septic shock patients rapidly decreased in a linear manner over 14 days and may predict physical function after critical care.

Gene Expression Patterns Distinguish Mortality Risk in Patients with Postsurgical Shock

Nowadays, mortality rates in intensive care units are the highest of all hospital units. However, there is not a reliable prognostic system to predict the likelihood of death in patients with postsurgical shock. Thus, the aim of the present work is to obtain a gene expression signature to distinguish the low and high risk of death in postsurgical shock patients. In this sense, mRNA levels were evaluated by microarray on a discovery cohort to select the most differentially expressed genes between surviving and non-surviving groups 30 days after the operation. Selected genes were evaluated by quantitative real-time polymerase chain reaction (qPCR) in a validation cohort to validate the reliability of data. A receiver-operating characteristic analysis with the area under the curve was performed to quantify the sensitivity and specificity for gene expression levels, which were compared with predictions by established risk scales, such as acute physiology and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA). IL1R2, CD177, RETN, and OLFM4 genes were upregulated in the non-surviving group of the discovery cohort, and their predictive power was confirmed in the validation cohort. This work offers new biomarkers based on transcriptional patterns to classify the postsurgical shock patients according to low and high risk of death. The results present more accuracy than other mortality risk scores.