Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 11, Number 12, December 2019, pages 834-841


Skeletal Muscle Index at Intensive Care Unit Admission Is a Predictor of Intensive Care Unit-Acquired Weakness in Patients With Sepsis

Figures

Figure 1.
Figure 1. Study flowchart. MV: mechanical ventilator; ICU-AW: intensive care unit-acquired weakness; MRC: Medical Research Council.
Figure 2.
Figure 2. Prevalence of various underlying basic disorders in both groups of patients with sepsis.
Figure 3.
Figure 3. ROC curves for SMI at ICU admission in prediction of ICU-AW (n = 31). ROC: receiver operating characteristic; SMI: skeletal muscle index; ICU-AW: intensive care unit-acquired weakness. The ROC analysis identified a cut-off point of 44.1 cm2/m2 (area under the curve: 0.745; sensitivity 78.3%; specificity 25.0%; P = 0.042).

Tables

Table 1. Comparison of Baseline Characteristics Between Groups With and Without ICU-AW
 
Group AW (n = 23)Group NAW (n = 8)P value
Data are expressed as means ± standard deviation. Categorical variables were compared using Fisher’s exact test, and continuous variables were compared using the Mann-Whitney U test. BMI: body mass index; APACHE: Acute Physiology and Chronic Health Evaluation; ICU-AW: AW: acquired weakness; NAW: non-acquired weakness.
Age (years)66.0 ± 11.966.1 ± 13.30.511
Gender, male (%)7 (30.4%)6 (75.0%)0.043
BMI (kg/m2)24.5 ± 5.024.3 ± 1.9< 0.999
Height155.7 ± 11.9162.0 ± 13.10.182
Weight (kg)63.1 ± 14.759.6 ± 14.20.443
Barthel index13.0 ± 19.616.2 ± 16.60.305
APACHE II score22.8 ± 8.817.8 ± 4.10.167

 

Table 2. Comparison of Laboratory Parameters Between Groups With and Without ICU-AW at ICU Admission and ICU Discharge
 
ICU admissionICU discharge
Group AW (n = 23)Group NAW (n = 8)P valueGroup AW (n = 23)Group NAW (n = 8)P value
Data are expressed as means ± standard deviation. Categorical variables were compared using Fisher’s exact test, and continuous variables were compared using the Mann-Whitney U test. Alb: serum albumin; BUN: blood urea nitrogen; Cre: creatinine; CRP: C-reactive protein; AST: aspartate aminotransferase; ALT: alanine aminotransferase; T-bil: total bilirubin; CK: creatine kinase; WBC: white blood cell count; ICU-AW: intensive care unit-acquired weakness; AW: acquired weakness; NAW: non-acquired weakness.
Alb (g/dL)2.08 ± 0.41.9 ± 0.40.4962.1 ± 0.42.1 ± 0.30.602
BUN (mg/dL)44.4 ± 18.645.0 ± 29.00.76928.5 ± 22.516.6 ± 5.80.09
Cre (mg/dL)1.9 ± 1.32.9 ± 2.70.8921.1 ± 1.40.6 ± 0.30.391
CRP (mg/dL)24.5 ± 9.624.1 ± 6.80.9648.7 ± 7.98.7 ± 7.90.964
Glucose (mg/dL)155.3 ± 108.9142.5 ± 57.30.701121.2 ± 28.7136 ± 30.20.13
Lactate (mg/dL)4.2 ± 3.23.1 ± 1.60.541.3 ± 0.71.1 ±0.10.329
AST (U/L)349.1 ± 925.9132.7 ± 185.20.85731.3 ± 21.342.7 ± 240.175
ALT(U/L)248.2 ± 763.860.5 ± 71.10.78633.6 ± 35.352.7 ± 38.50.114
T-bil (mg/dL)1.54 ± 1.21.8 ± 1.10.4420.9 ± 11 ± 0.70.275
CK (U/L)887.3 ± 1435.61117.1 ± 1733.60.68547.3 ± 80.1101 ± 134.10.175
WBC (103/µL)9536.5 ± 7131.58405.0 ± 6932.10.4989536.5 ± 7131.58405 ± 6932.10.391
PO2 (mm Hg +)121 ± 117.083.3 ± 19.20.54282.2 ± 1583.2 ± 130.769
pH7.4 ± 0.17.4 ± 0.10.5577.4 ± 07.4 ± 00.701
PCO2 (mm Hg +)31.4 ± 6.730.7 ± 7.90.87439.4 ± 7.936.2 ± 5.50.404

 

Table 3. Factors Associated With ICU Discharge and Hospital Discharge
 
Group AW (n = 23)Group NAW (n = 8)P value
Data are expressed as means ± standard deviation or as n (%). Categorical variables were compared using Fisher’s exact test, and continuous variables were compared using the Mann-Whitney U test. BMI: body mass index; ICU LOS: intensive care unit length of stay; MV: mechanical ventilation; AW: acquired weakness; NAW: non-acquired weakness.
BMI23.3 ± 5.422.8 ± 2.10.874
ICU LOS (day)23.4 ± 20.611.8 ± 8.30.214
Hospital LOS (day)95.5 ± 61.932.3 ± 14.10.007
Days until first upright sitting (day)25.4 ± 35.68.8 ± 80.015
Days until first sitting in a wheelchair (day)26.2 ± 27.29.2 ± 7.90.007
Blood purification therapy (%)7 (30.4%)1 (12.5%)0.642
Barthel index49.7 ± 33.381.2 ± 21.10.021
MV day5.9 ± 7.52.6 ± 2.20.243

 

Table 4. Assessment of Skeletal Muscle Index
 
ICU admissionICU discharge
Group AW (n = 23)Group NAW (n = 8)P valueGroup AW (n = 23)Group NAW (n = 8)P value
Data are expressed as means ± standard deviation. Categorical variables were compared using Fisher’s exact test, and continuous variables were compared using the Mann-Whitney U test. CT: computed tomography; SMI: skeletal muscle index; ICU: intensive care unit; AW: acquired weakness; NAW: non-acquired weakness.
Days until CT imaging0.5 ± 1.31.3 ± 2.50.24118.1 ± 11.814.3 ± 5.70.825
SMI40.7 ± 9.446.4 ± 6.40.04236.9 ± 6.443.4 ± 4.10.029

 

Table 5. Comparison of Skeletal Muscle Index With ICU-AW
 
Lower SMI (n = 20)Higher SMI (n = 11)P value
Data are expressed as n (%). P < 0.05 was considered significant. Categorical variables were compared by Fisher’s exact test. ICU-AW: intensive care unit-acquired weakness; SMI: skeletal muscle index.
ICU-AW +18 (58.0)5 (16.1)0.012
ICU-AW -2 (6.4)6 (19.3)

 

Table 6. Logistic Regression Analysis of Variables Associated With Skeletal Muscle Index
 
VariableOR (95% CI)P valuePercentage of correct classifications
Data were analyzed by logistic regression analysis model. OR: odds ratio; CI: confidence interval; SMI: skeletal muscle index; ICU: intensive care unit.
SMI at ICU admission
  > 44.1 cm2/m21.000
  ≤ 44.1 cm2/m210.800 (1.644 - 70.934)0.01377.4%