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Title
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Acute Outcomes and 1-Year Mortality of Intensive Care Unit-acquired Weakness A Cohort Study and Propensity-matched Analysis
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Author
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Abstract
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| Rationale: Intensive care unit (ICU)-acquired weakness is a frequent complication of critital 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. |
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Language
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English
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Source (journal)
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American journal of respiratory and critical care medicine. - New York, 1994, currens
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Publication
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New York
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2014
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ISSN
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1073-449X
[print]
1535-4970
[online]
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DOI
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10.1164/RCCM.201312-2257OC
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Volume/pages
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190
:4
(2014)
, p. 410-420
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ISI
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000340690900012
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Pubmed ID
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24825371
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Full text (Publisher's DOI)
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