Acute Outcomes and 1-year Mortality of Intensive Care Unit-Acquired Weakness. A Cohort Study and Propensity-Matched Analysis

Am J Respir Crit Care Med. 2014 Aug 15;190(4):410-20. doi: 10.1164/rccm.201312-2257OC.

Abstract

Rationale: 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.

Objectives: 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.

Measurements and main 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).

Trial registration: ClinicalTrials.gov NCT00512122.

Keywords: costs and cost analysis; critical illness; mortality; muscle strength; muscle weakness.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Critical Care / economics
  • Critical Care / methods
  • Critical Care / statistics & numerical data*
  • Critical Illness / economics
  • Critical Illness / rehabilitation
  • Female
  • Health Care Costs / statistics & numerical data
  • Humans
  • Intensive Care Units / economics
  • Intensive Care Units / statistics & numerical data*
  • Length of Stay / statistics & numerical data*
  • Male
  • Middle Aged
  • Muscle Weakness / economics
  • Muscle Weakness / mortality*
  • Muscle Weakness / rehabilitation
  • Patient Outcome Assessment*
  • Proportional Hazards Models
  • Prospective Studies
  • Respiration, Artificial / economics
  • Respiration, Artificial / methods
  • Respiration, Artificial / statistics & numerical data
  • Risk Factors
  • Severity of Illness Index

Associated data

  • ClinicalTrials.gov/NCT00512122