Risk factors in critical illness myopathy during the early course of critical illness: a prospective observational study

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• 作者：Steffen Weber-Carstens (1) (2)
  Maria Deja (1) (2)
  Susanne Koch (1) (2)
  Joachim Spranger (3)
  Florian Bubser (1) (2)
  Klaus D Wernecke (4)
  Claudia D Spies (1) (2)
  Simone Spuler (5)
  Didier Keh (1) (2)
  
• 刊名：Critical Care
• 出版年：2010
• 出版时间：June 2010
• 年：2010
• 卷：14
• 期：3
• 全文大小：
• 作者单位：Steffen Weber-Carstens (1) (2)
  Maria Deja (1) (2)
  Susanne Koch (1) (2)
  Joachim Spranger (3)
  Florian Bubser (1) (2)
  Klaus D Wernecke (4)
  Claudia D Spies (1) (2)
  Simone Spuler (5)
  Didier Keh (1) (2)
  
  1. Clinic of Anesthesiology and Intensive Care Medicine, Charité University Medicine, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
  2. Clinic of Anesthesiology and Intensive Care Medicine, Charité University Medicine, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
  3. Clinic of Endocrinology, Diabetes and Nutritional Medicine, Charité University Medicine, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
  4. Institute of Medical Biometry, Charité University Medicine, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
  5. Muscle Research Unit, Experimental and Clinical Research Center, Charité University Medicine, Campus Berlin Buch, Lindenberger Weg 80, 13125, Berlin, Germany
  
• ISSN：1364-8535

文摘

Introduction Non-excitable muscle membrane indicates critical illness myopathy (CIM) during early critical illness. We investigated predisposing risk factors for non-excitable muscle membrane at onset of critical illness. Methods We performed sequential measurements of muscle membrane excitability after direct muscle stimulation (dmCMAP) in 40 intensive care unit (ICU) patients selected upon a simplified acute physiology (SAPS-II) score ≥ 20 on 3 successive days within 1 week after ICU admission. We then investigated predisposing risk factors, including the insulin-like growth factor (IGF)-system, inflammatory, metabolic and hemodynamic parameters, as well as suspected medical treatment prior to first occurrence of abnormal dmCMAP. Nonparametric analysis of two-factorial longitudinal data and multivariate analysis were used for statistical analysis. Results 22 patients showed abnormal muscle membrane excitability during direct muscle stimulation within 7 (5 to 9.25) days after ICU admission. Significant risk factors for the development of impaired muscle membrane excitability in univariate analysis included inflammation, disease severity, catecholamine and sedation requirements, as well as IGF binding protein-1 (IGFBP-I), but did not include either adjunctive hydrocortisone treatment in septic shock, nor administration of neuromuscular blocking agents or aminoglycosides. In multivariate Cox regression analysis, interleukin-6 remained the significant risk factor for the development of impaired muscle membrane excitability (HR 1.006, 95%-CI (1.002 to 1.011), P = 0.002). Conclusions Systemic inflammation during early critical illness was found to be the main risk factor for development of CIM during early critical illness. Inflammation-induced impairment of growth-factor mediated insulin sensitivity may be involved in the development of CIM.