Yuchen Wu, Yatao Liu, Guoqiang Wang, Ang Zheng, Zhigang Zhang, Huaping Wei, Xin Wang
{"title":"切尔西重症监护物理评估工具诊断机械通气患者重症监护病房获得性虚弱的最佳分界点：一项多中心观察研究","authors":"Yuchen Wu, Yatao Liu, Guoqiang Wang, Ang Zheng, Zhigang Zhang, Huaping Wei, Xin Wang","doi":"10.1111/nicc.70018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The Chelsea Critical Care Physical Assessment Tool (CPAx) may be an optimal tool for diagnosing intensive care unit-acquired weakness (ICU-AW). However, we do not know the cut-off point for the diagnosis of ICU-AW.</p><p><strong>Aim: </strong>To ascertain the best cut-off point for CPAx to diagnose ICU-AW in adult patients with mechanical ventilation.</p><p><strong>Study design: </strong>A multicentre, prospective cross-sectional study. Participants were recruited from five ICUs in China that ranged from 20 June 2021 to 31 July 2023. The Medical Research Council Sum Scale (MRC-ss) <48 was taken as the standard to calculate the area under the curve (AUC) of CPAx. The cut-off point was determined by the maximum value of Youden Index (YI<sub>max</sub>). The kappa (κ) test was used to test the consistency of the MRC-ss and CPAx.</p><p><strong>Results: </strong>The AUC at baseline, weaning and discharge time point was 0.87 (95% CI 0.81-0.93), 0.96 (95% CI 0.92-0.99) and 0.91 (95% CI 0.86-0.96), respectively. Correspondingly, The YImax was 0.62, 0.91 and 0.65. The best cut-off point of CPAx score to diagnose ICU-AW at baseline, weaning and discharge time point was 30.5 (sensitivity = 72%, specificity = 89%), 31.5 (sensitivity = 95%, specificity = 90%) and 31.5 (sensitivity = 94%, specificity = 71%), respectively. Due to the CPAx being an ordinal scale, it was determined preliminarily that the cut-off point for the CPAx to diagnose ICU-AW was 31 points. We took CPAx ≤31 and MRC-ss <48 as criteria to diagnose ICU-AW and test the consistency of MRC-ss and CPAx. The results showed that there was no significant difference in the incidence of ICU-AW at different time points.</p><p><strong>Conclusions: </strong>The optimal cut-off point for the CPAx to diagnose ICU-AW is a score of 31 and it has good sensitivity and specificity.</p><p><strong>Relevance to clinical practice: </strong>The CPAx ≤31 score to diagnose ICU-acquired weakness (ICU-AW) has good sensitivity and specificity, and it can help to predict the risk of ICU-AW and guide medical personnel to make interventions.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70018"},"PeriodicalIF":3.0000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An optimal cut-off point for the Chelsea Critical Care Physical Assessment Tool to diagnose intensive care unit-acquired weakness in patients with mechanical ventilation: A multicentre observational study.\",\"authors\":\"Yuchen Wu, Yatao Liu, Guoqiang Wang, Ang Zheng, Zhigang Zhang, Huaping Wei, Xin Wang\",\"doi\":\"10.1111/nicc.70018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The Chelsea Critical Care Physical Assessment Tool (CPAx) may be an optimal tool for diagnosing intensive care unit-acquired weakness (ICU-AW). However, we do not know the cut-off point for the diagnosis of ICU-AW.</p><p><strong>Aim: </strong>To ascertain the best cut-off point for CPAx to diagnose ICU-AW in adult patients with mechanical ventilation.</p><p><strong>Study design: </strong>A multicentre, prospective cross-sectional study. Participants were recruited from five ICUs in China that ranged from 20 June 2021 to 31 July 2023. The Medical Research Council Sum Scale (MRC-ss) <48 was taken as the standard to calculate the area under the curve (AUC) of CPAx. The cut-off point was determined by the maximum value of Youden Index (YI<sub>max</sub>). The kappa (κ) test was used to test the consistency of the MRC-ss and CPAx.</p><p><strong>Results: </strong>The AUC at baseline, weaning and discharge time point was 0.87 (95% CI 0.81-0.93), 0.96 (95% CI 0.92-0.99) and 0.91 (95% CI 0.86-0.96), respectively. Correspondingly, The YImax was 0.62, 0.91 and 0.65. The best cut-off point of CPAx score to diagnose ICU-AW at baseline, weaning and discharge time point was 30.5 (sensitivity = 72%, specificity = 89%), 31.5 (sensitivity = 95%, specificity = 90%) and 31.5 (sensitivity = 94%, specificity = 71%), respectively. Due to the CPAx being an ordinal scale, it was determined preliminarily that the cut-off point for the CPAx to diagnose ICU-AW was 31 points. We took CPAx ≤31 and MRC-ss <48 as criteria to diagnose ICU-AW and test the consistency of MRC-ss and CPAx. The results showed that there was no significant difference in the incidence of ICU-AW at different time points.</p><p><strong>Conclusions: </strong>The optimal cut-off point for the CPAx to diagnose ICU-AW is a score of 31 and it has good sensitivity and specificity.</p><p><strong>Relevance to clinical practice: </strong>The CPAx ≤31 score to diagnose ICU-acquired weakness (ICU-AW) has good sensitivity and specificity, and it can help to predict the risk of ICU-AW and guide medical personnel to make interventions.</p>\",\"PeriodicalId\":51264,\"journal\":{\"name\":\"Nursing in Critical Care\",\"volume\":\"30 3\",\"pages\":\"e70018\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nursing in Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/nicc.70018\",\"RegionNum\":3,\"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":"Nursing in Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/nicc.70018","RegionNum":3,"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
背景：切尔西重症监护身体评估工具（CPAx）可能是诊断重症监护病房获得性虚弱（ICU-AW）的最佳工具。然而，我们不知道诊断ICU-AW的分界点。目的：确定CPAx诊断成人机械通气患者ICU-AW的最佳截断点。研究设计：一项多中心、前瞻性横断面研究。参与者从2021年6月20日至2023年7月31日期间在中国的五个icu中招募。医学研究委员会总金额表（MRC-ss）最高)。采用kappa （κ）试验检测MRC-ss与CPAx的一致性。结果：基线、断奶和出院时间点的AUC分别为0.87 （95% CI 0.81 ~ 0.93）、0.96 （95% CI 0.92 ~ 0.99）和0.91 （95% CI 0.86 ~ 0.96）。相应的，imax分别为0.62、0.91和0.65。基线、断奶和出院时间点CPAx评分诊断ICU-AW的最佳分界点分别为30.5（敏感性72%，特异性89%）、31.5（敏感性95%，特异性90%）和31.5（敏感性94%，特异性71%）。由于CPAx是一个序数量表，初步确定CPAx诊断ICU-AW的分界点为31分。结论：CPAx诊断ICU-AW的最佳分界点为31分，具有良好的敏感性和特异性。与临床实践的相关性：CPAx≤31分诊断ICU-acquired weak （ICU-AW）具有良好的敏感性和特异性，有助于预测ICU-AW的风险，指导医护人员采取干预措施。
An optimal cut-off point for the Chelsea Critical Care Physical Assessment Tool to diagnose intensive care unit-acquired weakness in patients with mechanical ventilation: A multicentre observational study.
Background: The Chelsea Critical Care Physical Assessment Tool (CPAx) may be an optimal tool for diagnosing intensive care unit-acquired weakness (ICU-AW). However, we do not know the cut-off point for the diagnosis of ICU-AW.
Aim: To ascertain the best cut-off point for CPAx to diagnose ICU-AW in adult patients with mechanical ventilation.
Study design: A multicentre, prospective cross-sectional study. Participants were recruited from five ICUs in China that ranged from 20 June 2021 to 31 July 2023. The Medical Research Council Sum Scale (MRC-ss) <48 was taken as the standard to calculate the area under the curve (AUC) of CPAx. The cut-off point was determined by the maximum value of Youden Index (YImax). The kappa (κ) test was used to test the consistency of the MRC-ss and CPAx.
Results: The AUC at baseline, weaning and discharge time point was 0.87 (95% CI 0.81-0.93), 0.96 (95% CI 0.92-0.99) and 0.91 (95% CI 0.86-0.96), respectively. Correspondingly, The YImax was 0.62, 0.91 and 0.65. The best cut-off point of CPAx score to diagnose ICU-AW at baseline, weaning and discharge time point was 30.5 (sensitivity = 72%, specificity = 89%), 31.5 (sensitivity = 95%, specificity = 90%) and 31.5 (sensitivity = 94%, specificity = 71%), respectively. Due to the CPAx being an ordinal scale, it was determined preliminarily that the cut-off point for the CPAx to diagnose ICU-AW was 31 points. We took CPAx ≤31 and MRC-ss <48 as criteria to diagnose ICU-AW and test the consistency of MRC-ss and CPAx. The results showed that there was no significant difference in the incidence of ICU-AW at different time points.
Conclusions: The optimal cut-off point for the CPAx to diagnose ICU-AW is a score of 31 and it has good sensitivity and specificity.
Relevance to clinical practice: The CPAx ≤31 score to diagnose ICU-acquired weakness (ICU-AW) has good sensitivity and specificity, and it can help to predict the risk of ICU-AW and guide medical personnel to make interventions.
期刊介绍：
Nursing in Critical Care is an international peer-reviewed journal covering any aspect of critical care nursing practice, research, education or management. Critical care nursing is defined as the whole spectrum of skills, knowledge and attitudes utilised by practitioners in any setting where adults or children, and their families, are experiencing acute and critical illness. Such settings encompass general and specialist hospitals, and the community. Nursing in Critical Care covers the diverse specialities of critical care nursing including surgery, medicine, cardiac, renal, neurosciences, haematology, obstetrics, accident and emergency, neonatal nursing and paediatrics.
Papers published in the journal normally fall into one of the following categories:
-research reports
-literature reviews
-developments in practice, education or management
-reflections on practice
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
