危重病人肌肉力量轨迹和结局：一项前瞻性多中心队列研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing Pub Date : 2025-01-08 DOI:10.1016/j.iccn.2024.103934

Ting-Ting Wu , Xiu-Xia Lin , Gao-Yan Chen , Jun Yao , Jing Xiong , Chen-Juan Luo , Yao-Ning Zhuang , Mei-Lian Xu , Xue-Xian Chen , Mei-Rong Chen , Hong Li

{"title":"危重病人肌肉力量轨迹和结局：一项前瞻性多中心队列研究。","authors":"Ting-Ting Wu , Xiu-Xia Lin , Gao-Yan Chen , Jun Yao , Jing Xiong , Chen-Juan Luo , Yao-Ning Zhuang , Mei-Lian Xu , Xue-Xian Chen , Mei-Rong Chen , Hong Li","doi":"10.1016/j.iccn.2024.103934","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.</div></div><div><h3>Design</h3><div>Prospective multicenter cohort study.</div></div><div><h3>Settings</h3><div>Ten ICUs across five tertiary hospitals in Fujian Province, China.</div></div><div><h3>Methods</h3><div>Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005–0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (<em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.</div></div><div><h3>Implications for clinical practice</h3><div>Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103934"},"PeriodicalIF":4.9000,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Muscle strength trajectories and outcomes in critically ill patients: A prospective multicentre cohort study\",\"authors\":\"Ting-Ting Wu , Xiu-Xia Lin , Gao-Yan Chen , Jun Yao , Jing Xiong , Chen-Juan Luo , Yao-Ning Zhuang , Mei-Lian Xu , Xue-Xian Chen , Mei-Rong Chen , Hong Li\",\"doi\":\"10.1016/j.iccn.2024.103934\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.</div></div><div><h3>Design</h3><div>Prospective multicenter cohort study.</div></div><div><h3>Settings</h3><div>Ten ICUs across five tertiary hospitals in Fujian Province, China.</div></div><div><h3>Methods</h3><div>Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005–0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (<em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.</div></div><div><h3>Implications for clinical practice</h3><div>Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.</div></div>\",\"PeriodicalId\":51322,\"journal\":{\"name\":\"Intensive and Critical Care Nursing\",\"volume\":\"88 \",\"pages\":\"Article 103934\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-01-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Intensive and Critical Care Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0964339724003203\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intensive and Critical Care Nursing","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0964339724003203","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

摘要

目的：研究ICU患者肌肉力量的变化轨迹和决定因素及其对1、6和12个月死亡率的影响。设计：前瞻性多中心队列研究。地点：福建省5家三级医院的10个icu。方法：在ICU入院、ICU出院和出院三个时间点，用握力评估肌肉力量。采用基于组的轨迹建模来识别肌肉力量轨迹，而多项逻辑分析则根据基线特征确定预测因子。死亡率结果采用Cox比例风险模型进行评估，该模型经治疗加权逆概率调整。结果：在317例患者中，37例在12个月内死亡，确定了三种肌肉力量轨迹：低水平稳定（38.17%），中等水平改善（47.00%）和高水平改善（14.83%）。年龄较大（≥65岁）、女性、机械通气时间延长和无脂量较低与进入低水平稳定性组的可能性较高相关。调整后，与低水平稳定组相比，中等水平改善组1个月死亡风险降低0.067倍（95% CI: 0.005-0.825）， 6个月或12个月无显著差异（P < 0.05）。结论：确定了三种不同的肌肉力量轨迹：低水平稳定性，中等水平改善和高水平改善。年龄较大、女性、机械通气时间延长、无脂量较低与低水平稳定组密切相关，低水平稳定组1个月死亡率较高。对临床实践的启示：本研究的发现强调了早期识别低水平稳定性患者的重要性，特别是那些年龄较大、需要长时间机械通气或无脂量减少的女性患者。对这些高危人群进行量身定制的早期康复治疗可能会带来实质性的临床益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Muscle strength trajectories and outcomes in critically ill patients: A prospective multicentre cohort study

Objectives

To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.

Design

Prospective multicenter cohort study.

Settings

Ten ICUs across five tertiary hospitals in Fujian Province, China.

Methods

Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.

Results

Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005–0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (P > 0.05).

Conclusions

Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.

Implications for clinical practice

Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.