Clinical Study of Predictive Value of Risk Factors for Intensive Care Unit-acquired Weakness in Critically Ill Elderly Patients

Objective To explore the predictive factors of ICU-acquired weakness in critically ill elderly patients and to investigate their predictive value in clinical diagnosis. Methods An observational cohort study was conducted on patients admitted to the department of critical care medicine at Beijing Fu xing Hospital Capital Medical University, from June 2017 to October 2018. Muscle strength was assessed using the medical research council score on the day the patients regained consciousness. Based on the clinical muscle strength assessment results, patients were divided into the experimental group (muscle strength score < 48 scores) and the control group (≥48 scores) . Relevant factors for both groups were collected and compared. Multivariate logistic regression analysis was used to assess the independent risk factors for ICU-acquired weakness in critically ill elderly patients. The predictive value of each indicator for ICU-acquired weakness on elderly patients was evaluated using ROC curves. Results A total of 62 awake elderly critically ill patients were collected. Among them, 30 patients diagnosed with ICU-acquired weakness (prevalence rate of 48.39% ) were designated as the experimental group, and 32 patients without ICU-acquired weakness were designated as the control group. Significant differences were found between the two groups in terms of acute physiology and chronic health evaluation (APACHE) Ⅱ scores, sequential organ failure assessment scores, duration of systemic inflammatory response syndrome, duration of sepsis, septic shock, duration of shock, multiple organ dysfunction and its duration, use of norepinephrine and its duration, duration of mechanical ventilation, use of neuromuscular blocking agents and their duration, hypocalcemia, and electrolyte disturbances (P < 0.05) . Multivariate logistic regression analysis indicated that APACHE Ⅱ score and duration of norepinephrine use were independent risk factors for ICU-acquired weakness in elderly critically ill patients (P < 0.05) . The ROC curve suggested that the optimal predictive performance was achieved when norepinephrine was used for more than 3 days and the APACHE Ⅱ score was greater than 20 points. Conclusion In elderly critically ill patients, APACHE Ⅱ score and duration of norepinephrine use are independent risk factors and good predictive indicators for ICU-acquired weakness.