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01-12-2015 | Original

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

Authors: Greet Hermans, Helena Van Mechelen, Frans Bruyninckx, Tine Vanhullebusch, Beatrix Clerckx, Philippe Meersseman, Yves Debaveye, Michael P. Casaer, Alexander Wilmer, Pieter J. Wouters, Ilse Vanhorebeek, Rik Gosselink, Greet Van den Berghe

Published in: Intensive Care Medicine | Issue 12/2015

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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Title: Predictive value for weakness and 1-year mortality of screening electrophysiology tests in the ICU
Authors: Greet Hermans
Helena Van Mechelen
Frans Bruyninckx
Tine Vanhullebusch
Beatrix Clerckx
Philippe Meersseman
Yves Debaveye
Michael P. Casaer
Alexander Wilmer
Pieter J. Wouters
Ilse Vanhorebeek
Rik Gosselink
Greet Van den Berghe
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3979-7

At a glance: The STEP trials

Springer Medicine

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

Purpose

Abstract

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Purpose

Abstract

Methods

Results

Conclusions

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