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Acquired Weakness, Handgrip Strength, and Mortality in Critically Ill Patients

¹ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, ² Department of Internal Medicine, Center for Biostatistics, Ohio State University, Columbus, Ohio; ³ Division of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; ⁴ Division of Pulmonary and Critical Care Medicine, MetroHealth Medical Center, Cleveland, OH; ⁵ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio; ⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University Hospitals Case Medical Center, Case-Western Reserve University, Cleveland, Ohio; ⁷ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Indiana University Medical Center, Indianapolis, Indiana; ⁸ College of Public Health, Ohio State University, Columbus, Ohio; and ⁹ Department of Internal Medicine, MetroHealth Medical Center, Columbus, Ohio

Correspondence and requests for reprints should be addressed to Naeem A. Ali, M.D., 201G DHLRI, 473 W. 12th Avenue, Columbus, OH 43221. E-mail: Naeem.ali{at}osumc.edu

Rationale: ICU-acquired paresis (ICUAP) is common in survivors of critical illness. There is significant associated morbidity, including prolonged time on the ventilator and longer hospital stay. However, it is unclear whether ICUAP is independently associated with mortality, as sicker patients are more prone and existing studies have not adjusted for this.

Objectives: To test the hypothesis that ICUAP is independently associated with increased mortality. Secondarily, to determine if handgrip dynamometry is a concise measure of global strength and is independently associated with mortality.

Methods: A prospective multicenter cohort study was conducted in intensive care units (ICU) of five academic medical centers. Adults requiring at least 5 days of mechanical ventilation without evidence of preexisting neuromuscular disease were followed until awakening and were then examined for strength.

Measurements and Main Results: We measured global strength and handgrip dynamometry. The primary outcome was in-hospital mortality and secondary outcomes were hospital and ICU-free days, ICU readmission, and recurrent respiratory failure. Subjects with ICUAP (average MRC score of < 4) had longer hospital stays and required mechanical ventilation longer. Handgrip strength was lower in subjects with ICUAP and had good test performance for diagnosing ICUAP. After adjustment for severity of illness, ICUAP was independently associated with hospital mortality (odds ratio [OR], 7.8; 95% confidence interval [CI], 2.4–25.3; P = 0.001). Separately, handgrip strength was independently associated with hospital mortality (OR, 4.5; 95% CI, 1.5–13.6; P = 0.007).

Conclusions: ICUAP is independently associated with increased hospital mortality. Handgrip strength is also independently associated with poor hospital outcome and may serve as a simple test to identify ICUAP.

Clinical trial registered with www.clinicaltrials.gov (NCT00106665).

Key Words: polyneuropathy, critical illness • muscle weakness • hand strength

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Intensive care unit (ICU)-acquired weakness is a known complication of critical illness that has significant associated morbidity. What This Study Adds to the Field ICU-acquired weakness is independently associated with increased hospital mortality. Handgrip strength may serve also as a simple test to identify ICU-acquired paresis.