Weakness in the ICU: the right weight on the right scale
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Weakness in the ICU: the right weight on the right scale Nathalie Van Aerde1, Greet Van den Berghe1,2 and Greet Hermans1,3* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, We thank Okazaki and Taito for their thoughtful comments [1] on our prospective observational study on the impact of ICU-acquired neuromuscular dysfunctions on 5-year outcomes [2]. First, the authors suggest that ICU-acquired neuromuscular complications may only impact 1-year mortality. This hypothesis is based on their interpretation that the survival curves are no longer widening after 1 year. In reply, we now provide the Kaplan– Meier curves for 1-year survivors, up to 5-year follow-up (Fig. 1). These show that a significant survival difference remains present for patients with last ICU MRC ≤ 55 versus > 55, and abnormal versus normal CMAP on day 8 ± 1. This finding is consistent with the sensitivity analyses reported in our paper [2], showing that the proportional hazards assumption was not violated for MRC ≤ 55 nor for abnormal CMAP in the multivariable 5-year survival Cox-regression model. Hence, an independent association between neuromuscular dysfunctions and mortality persists throughout the entire 5-year follow-up. In contrast with the Kaplan–Meier plots, these analyses are adjusted for confounders, and therefore present a better model to validate our conclusions. Second, with respect to the cut-off of 55 for MRC, importantly, we primarily analyzed MRC as a continuous variable and found that 5-year mortality and morbidity were increased for every point decrease in the MRC sum score, indicating that more pronounced loss of strength is associated with worse outcomes. We subsequently further explored these data to see whether an optimal threshold could be identified, predicting 5-year outcomes. These analyses suggest *Correspondence: [email protected] 3 Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Full author information is available at the end of the article
that, for the long-term perspective, the optimal threshold indeed is situated around 55. This is higher than the threshold of 48, which has been extensively validated as a cut-off for worse short-term outcomes. The number of patients with an MRC above the newly suggested threshold at ICU discharge in our cohort was 195/596 (32.7%). Therefore, it does seem to be a sensible threshold, dividing this population into groups with distinct outcomes. Last ICU MRC in our population was 51 (47–57) with MRC
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