ABSTRACT
Objective:
To explore the
risk factors of
intensive care unit acquired weakness (ICUAW) in
patients with
sepsis, and to evaluate the predictive value of each
risk factor for ICUAW.
Methods:
A
case control study was conducted, 60 septic
patients admitted to the
intensive care unit (ICU) of Henan Provincial People's
Hospital from October 20, 2020 to February 20, 2021 were enrolled. The
patients were divided into two groups
sepsis ICUAW group and
sepsis non-ICUAW group. The data of
gender, age,
body mass index (BMI),
acute physiology and chronic health evaluationⅡ(
APACHEⅡ) score,
complications,
mechanical ventilation, duration of ICUAW,
length of stay in ICU,
fasting blood glucose,
blood lactic acid (Lac),
procalcitonin (PCT),
C-reactive protein (CRP), sequential organ failure assessment (SOFA) score, outcome,
antimicrobial agent,
glucocorticoid,
sedatives and
analgesics drugs and vasoactive
drugs were collected.
Risk factors were screened by univariate
Logistic regression analysis, and
odds ratio ( OR) was adjusted by multivariate binary
logistic regression, P < 0.05 was considered as independent
risk factors. Finally, the
receiver operating characteristic curve (
ROC curve) was drawn to analyze the predictive value of independent
risk factors.
Results:
The
APACHEⅡ score of the
sepsis ICUAW group was significantly higher than that of the
sepsis non-ICUAW group (23.05±8.17 vs. 15.33±4.89, P < 0.05), the total
length of stay in the ICU was significantly longer than that of the
sepsis non-ICUAW group (days 15.1±9.2 vs. 8.5±3.4, P < 0.05), the improvement rate of
patients was significantly lower than that of the
sepsis non-ICUAW group [45.0% (9/20) vs. 95.0% (38/40), P < 0.05]. After univariate
Logistic regression and multicollinearity test
analysis, 7 factors including
APACHEⅡ score, average SOFA score,
blood lactic acid, proportion of
mechanical ventilation,
sedatives and
analgesics drugs, type of
antibiotics and type of vasoactive
drugs were included in the binary
Logistic regression model [ OR 1.21, 2.05, 2.26, 0.21, 1.54, 2.07, 1.38, 95%
confidence interval (95% CI) 1.09-1.35, 1.42-2.94, 1.12-4.57, 0.05-0.66, 1.03-2.29, 1.27-3.37, 0.96-2.00, all P < 0.05]. Hosmer-Lemchaw test P = 0.901, and the correct percentage of prediction was 85%, indicating good model fit. Multivariate binary
Logistic regression analysis showed that
APACHEⅡ score and average SOFA score were independent
risk factors for the occurrence of ICUAW in septic
patients (
APACHEⅡscore OR = 1.17, 95% CI was 1.004-1.376, P = 0.044; average SOFA score OR = 1.86, 95% CI was 1.157-2.981, P = 0.01).
ROC curve analysis showed that the mean value of
APACHEⅡ score, average SOFA score and their combined
detection had a certain predictive value for the occurrence of ICUAW in
sepsis patients, areas under
ROC curve (
AUC) were 0.787, 0.881, 0.905, 95% CI was 0.646-0.928, 0.791-0.972, 0.828-0.982, all P < 0.05. When the cut-off value was 19.500, 6.225, 0.375, the
sensitivity was 75%, 90%, 90%, and the
specificity were 80%, 80%, 85%, respectively.
Conclusion:
APACHEⅡ score and average SOFA score can be used as independent
risk factors for the occurrence of ICUAW in
sepsis, and their combined predictive value is better than that of individual index.