Abstract Details

Title Incidence, Risk Factors and Outcomes of Critical Illness Related Neuromuscular Weakness: A Population Based Case-Control Study

Topic Muscle Disease/Neuromuscular Junction

Presentation(s) P07 - (-)

Poster/Presentation
Number 045

Objective

Background BACKGROUND: Though hospital-based studies have found critical illness polyneuropathy and/or myopathy (CIPNM) as a common cause of weakness in ICU patients, CIPNM remains an underdiagnosed condition.

Design/Methods DESIGN/METHODS: Nationwide Inpatient Sample from years 2005-2010 was screened for adult patients with CIPNM by using ICD-9 codes. Cases with additional diagnoses of myasthenia, Guillain-Barre syndrome, and other causes of polyneuropathies and myopathies were excluded for diagnostic accuracy. Age and severity matched control group was selected from the same database with ratio of cases to controls of 1:25. Discharge outcomes and resource utilization were compared between the two groups. Independent predictors of CIPNM were identified by multivariate logistic regression. Population estimates were calculated by complex sample analysis using discharge weights.

Results RESULTS: We included 59,672 weighted cases of CIPNM in our analysis. Age-adjusted incidence of CIPNM was 4.2 (95% CI: 3.5-5) per 100,000 population. Patients with CIPNM were more likely (46.4% vs. 35.7%, p<.001) to have functional morbidity as indicated by discharge to skilled nursing facility/long-term care/home health care compared to the controls. Inpatient mortality was lower in CIPNM (7.5% vs. 13.3%, p<.001). CIPNM had longer hospital stay (mean±SD: 20.9±20.9 vs. 9.4±12 days, p<.001) and higher cost of inpatient care (49,929±65,276 vs. 23,543±33,186 USD, p<.001) compared to the control group. In adjusted analysis, factors associated with CIPNM were Caucasian race, mechanical ventilation, sepsis, organ transplant recipient, obesity, hypernatremia, collagen vascular disorder and anemia.

Conclusions CONCLUSIONS: Incidence of CIPNM in this study was lower than expected from the previous hospital based studies thus likely suggesting underdiagnosis in the US hospitals. CIPNM is associated with lower inpatient mortality and higher functional morbidity than age and severity matched controls. CIPNM associated factors should be explored in prospective studies to assess their predictive validity.

Authors/Disclosures
Yogesh Moradiya, MD PRESENTER	No disclosure on file
	No disclosure on file
Johanne Personna-Policard, MD	No disclosure on file
CHRISTOPHER R. JOHNSTON, DO (Jefferson Meadowbrook Neurology)	No disclosure on file
Sebina Bulic, MD (USC)	Dr. Bulic has nothing to disclose.
Noah Berkowitz	No disclosure on file
Yaacov Anziska, MD (SUNY-Downstate Medical Center)	Dr. Anziska has nothing to disclose.

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