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Predictive value for weakness and 1-year mortality of screening electrophysiology tests in the ICU

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Purpose

Abstract

Muscle weakness in long-stay ICU patients contributes to 1-year mortality. Whether electrophysiological screening is an alternative diagnostic tool in unconscious/uncooperative patients remains unknown. We aimed to determine the diagnostic properties of abnormal compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and spontaneous electrical activity (SEA) for Medical Research Council (MRC)-defined weakness and their predictive value for 1-year mortality.

Methods

Data were prospectively collected during the EPaNIC trial (ClinicalTrials.gov: NCT00512122). First, sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of abnormal CMAP, SNAP, and SEA for weakness were determined. Subsequently, association between 1-year mortality and abnormal findings on electrophysiological screening was assessed by univariate and multivariate analyses correcting for weakness and other risk factors and the prediction model involved only a development phase.

Results

A total of 730 patients were electrophysiologically screened of whom 432 were tested for weakness. On day 8, normal CMAP excluded weakness with a high NPV (80.5 %). By day 15, abnormal SNAP and the presence of SEA had a high PPV (91.7 and 80.0 %, respectively). Only a reduced CMAP on day 8 was associated with higher 1-year mortality [35.6 vs 15.2 % (p < 0.001)]. This association remained significant after correction for weakness and other risk factors [OR 2.463 (95 % CI 1.113–5.452), p = 0.026]. Also among conscious/cooperative patients without weakness, reduced CMAP was independently associated with a higher likelihood of death occurring during 1 year [HR 2.818 (95 % CI 1.074–7.391), p = 0.035].

Conclusions

The diagnostic properties of electrophysiological screening vary over time. Abnormal CMAP documented early during critical illness carries information about longer-term outcome, which should be further investigated mechanistically.

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Acknowledgments

We are indebted to all patients and their families for their participation in this study. The clinical trial assistants, in particular Alexandra Hendrickx, Sylvia Van Hulle, and Jenny Gielens, are acknowledged for administrative support. We are grateful to the ICU nursing and medical staff for excellent patient care. This work was supported by the Research Foundation-Flanders (FWO), Belgium (G.0399.12, G.0592.12). GH and MPC hold a Postdoctoral Fellowship from the Clinical Research Fund (KOF) of the University Hospitals Leuven, Belgium. GVdB, via the University of Leuven, receives structural research financing via the Methusalem program, funded by the Flemish Government (METH08/07) and holds an European Research Council (ERC) Advanced grant (AdvG-2012-321670) from the Ideas Program of the EU FP7.

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    Authors and Affiliations

    1. Laboratory of Intensive Care Medicine, Division of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

      Greet Hermans, Helena Van Mechelen, Tine Vanhullebusch, Yves Debaveye, Michael P. Casaer, Pieter J. Wouters, Ilse Vanhorebeek & Greet Van den Berghe

    2. Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals, Leuven, Belgium

      Greet Hermans, Philippe Meersseman & Alexander Wilmer

    3. Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium

      Frans Bruyninckx

    4. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

      Beatrix Clerckx, Yves Debaveye, Michael P. Casaer, Pieter J. Wouters & Greet Van den Berghe

    5. Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium

      Rik Gosselink

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    1. Greet Hermans
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    Correspondence to Greet Hermans.

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    G. Hermans and H. Van Mechelen contributed equally.

    Take-home message: The diagnostic properties of electrophysiological screening vary over time. Abnormal CMAP documented early during critical illness carries information about longer-term outcome.

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    Hermans, G., Van Mechelen, H., Bruyninckx, F. et al. Predictive value for weakness and 1-year mortality of screening electrophysiology tests in the ICU. Intensive Care Med 41, 2138–2148 (2015). https://doi.org/10.1007/s00134-015-3979-7

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