A Predictive Nomogram for Intensive Care-Acquired Weakness after Cardiopulmonary Bypass
Purpose: Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB.Methods: Baseline characteristics, preoperative...
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| Published in | Annals of Thoracic and Cardiovascular Surgery Vol. 30; no. 1; p. oa.23-00029 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
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The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery
25.01.2024
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| Abstract | Purpose: Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB.Methods: Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models.Results: Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram.Conclusion: A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making. |
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| AbstractList | Purpose: Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB.
Methods: Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models.
Results: Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram.
Conclusion: A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making. Purpose: Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB.Methods: Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models.Results: Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram.Conclusion: A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making. Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB.PURPOSEIntensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB.Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models.METHODSBaseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models.Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram.RESULTSApproximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram.A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making.CONCLUSIONA high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making. Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB. Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models. Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram. A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making. |
| ArticleNumber | oa.23-00029 |
| Author | Lin, Xueying Chen, Liangwan Zhong, Fuxiu Zhang, Haoruo Lin, Yanjuan Peng, Yanchun |
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An official American Thoracic Society Clinical Practice Guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med 2014; 190: 1437–46. 23) Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med 2016; 9: 229–55. 10) Bennett JA, Riegel B, Bittner V, et al. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung 2002; 31: 262–70. 4) Berger D, Bloechlinger S, von Haehling S, et al. Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. J Cachexia Sarcopenia Muscle 2016; 7: 403–12. 13) Nakano H, Naraba H, Hashimoto H, et al. Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle. Crit Care 2021; 25: 415. 16) Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014; 371: 287–8. 22) Dolgin M. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. The Criteria Committee of the New York Heart Association, 9th ed; 1994: 253–6. 18) Salameh A, Kühne L, Grassl M, et al. Protective effects of pulsatile flow during cardiopulmonary bypass. Ann Thorac Surg 2015; 99: 192–9. 28) Vincent JL, Quintairos e Silva A, Couto L, et al. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20: 257. 17) Latronico N, Herridge M, Hopkins RO, et al. The ICM research agenda on intensive care unit-acquired weakness. Intensive Care Med 2017; 43: 1270–81. 2) Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis. PLoS One 2019; 14: e0223185. 5) Connolly BA, Jones GD, Curtis AA, et al. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Crit Care 2013; 17: R229. 1) Chen X, Liao H, Gao W, et al. Cardiopulmonary bypass duration and the incidence of pressure injuries in patients undergoing cardiovascular surgery: a retrospective cohort study. J Wound Ostomy Continence Nurs 2020; 47: 343–8. 20) Yalçın M, Gödekmerdan E, Tayfur K, et al. The APACHE II score as a predictor of mortality after open heart surgery. Turk J Anaesthesiol Reanim 2019; 47: 41–7. 6) Caputo M, Mokhtari A, Miceli A, et al. Controlled reoxygenation during cardiopulmonary bypass decreases markers of organ damage, inflammation, and oxidative stress in single-ventricle patients undergoing pediatric heart surgery. J Thorac Cardiovasc Surg 2014; 148: 792–801.e8; discussion, 800–1. 12) Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med 2020; 46: 637–53. 25) Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr 2019; 43: 181–93. 8) Formenti P, Umbrello M, Coppola S, et al. Clinical review: peripheral muscular ultrasound in the ICU. Ann Intensive Care 2019; 9: 57. 19) Friedrich O, Reid MB, Van den Berghe G, et al. The sick and the weak: neuropathies/myopathies in the critically ill. Physiol Rev 2015; 95: 1025–109. 9) Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud 1988; 10: 64–7. 24) Reid MB, Judge AR, Bodine SC. CrossTalk opposing view: the dominant mechanism causing disuse muscle atrophy is proteolysis. J Physiol 2014; 592: 5345–7. 15) Wang W, Xu C, Ma X, et al. Intensive care unit-acquired weakness: a review of recent progress with a look toward the future. Front Med (Lausanne) 2020; 7: 559789. 29) Aune D, Sen A, Norat T, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: a systematic review and dose-response meta-analysis of prospective studies. Circulation 2016; 133: 639–49. 26) Farhan H, Moreno-Duarte I, Latronico N, et al. Acquired muscle weakness in the surgical intensive care unit: nosology, epidemiology, diagnosis, and prevention. Anesthesiology 2016; 124: 207–34. 27) Yang T, Li Z, Jiang L, et al. Hyperlactacidemia as a risk factor for intensive care unit-acquired weakness in critically ill adult patients. Muscle Nerve 2021; 64: 77–82. 22 23 24 25 26 27 28 29 30 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 26) Farhan H, Moreno-Duarte I, Latronico N, et al. Acquired muscle weakness in the surgical intensive care unit: nosology, epidemiology, diagnosis, and prevention. Anesthesiology 2016; 124: 207–34. – reference: 16) Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014; 371: 287–8. – reference: 10) Bennett JA, Riegel B, Bittner V, et al. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung 2002; 31: 262–70. – reference: 5) Connolly BA, Jones GD, Curtis AA, et al. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Crit Care 2013; 17: R229. – reference: 29) Aune D, Sen A, Norat T, et al. Body mass index, abdominal fatness, and heart failure incidence and mortality: a systematic review and dose-response meta-analysis of prospective studies. Circulation 2016; 133: 639–49. – reference: 2) Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: a systematic review and meta-analysis. PLoS One 2019; 14: e0223185. – reference: 23) Levitt DG, Levitt MD. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med 2016; 9: 229–55. – reference: 28) Vincent JL, Quintairos e Silva A, Couto L, et al. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016; 20: 257. – reference: 19) Friedrich O, Reid MB, Van den Berghe G, et al. The sick and the weak: neuropathies/myopathies in the critically ill. Physiol Rev 2015; 95: 1025–109. – reference: 9) Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud 1988; 10: 64–7. – reference: 21) Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13. – reference: 6) Caputo M, Mokhtari A, Miceli A, et al. Controlled reoxygenation during cardiopulmonary bypass decreases markers of organ damage, inflammation, and oxidative stress in single-ventricle patients undergoing pediatric heart surgery. J Thorac Cardiovasc Surg 2014; 148: 792–801.e8; discussion, 800–1. – reference: 22) Dolgin M. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. The Criteria Committee of the New York Heart Association, 9th ed; 1994: 253–6. – reference: 24) Reid MB, Judge AR, Bodine SC. CrossTalk opposing view: the dominant mechanism causing disuse muscle atrophy is proteolysis. J Physiol 2014; 592: 5345–7. – reference: 15) Wang W, Xu C, Ma X, et al. Intensive care unit-acquired weakness: a review of recent progress with a look toward the future. Front Med (Lausanne) 2020; 7: 559789. – reference: 18) Salameh A, Kühne L, Grassl M, et al. Protective effects of pulsatile flow during cardiopulmonary bypass. Ann Thorac Surg 2015; 99: 192–9. – reference: 3) Fan E, Cheek F, Chlan L, et al. An official American Thoracic Society Clinical Practice Guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med 2014; 190: 1437–46. – reference: 12) Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med 2020; 46: 637–53. – reference: 20) Yalçın M, Gödekmerdan E, Tayfur K, et al. The APACHE II score as a predictor of mortality after open heart surgery. Turk J Anaesthesiol Reanim 2019; 47: 41–7. – reference: 27) Yang T, Li Z, Jiang L, et al. Hyperlactacidemia as a risk factor for intensive care unit-acquired weakness in critically ill adult patients. Muscle Nerve 2021; 64: 77–82. – reference: 7) Grimm A, Teschner U, Porzelius C, et al. Muscle ultrasound for early assessment of critical illness neuromyopathy in severe sepsis. Crit Care 2013; 17: R227. – reference: 30) Valavanis IK, Mougiakakou SG, Grimaldi KA, et al. A multifactorial analysis of obesity as CVD risk factor: use of neural network based methods in a nutrigenetics context. BMC Bioinformatics 2010; 11: 453. – reference: 4) Berger D, Bloechlinger S, von Haehling S, et al. Dysfunction of respiratory muscles in critically ill patients on the intensive care unit. J Cachexia Sarcopenia Muscle 2016; 7: 403–12. – reference: 13) Nakano H, Naraba H, Hashimoto H, et al. Novel protocol combining physical and nutrition therapies, Intensive Goal-directed REhabilitation with Electrical muscle stimulation and Nutrition (IGREEN) care bundle. Crit Care 2021; 25: 415. – reference: 8) Formenti P, Umbrello M, Coppola S, et al. Clinical review: peripheral muscular ultrasound in the ICU. Ann Intensive Care 2019; 9: 57. – reference: 25) Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr 2019; 43: 181–93. – reference: 11) Gall JR, Loirat P, Alpcrovitch A. Apache II—a severity of disease classification system. Crit Care Med 1986; 14: 754–5. – reference: 17) Latronico N, Herridge M, Hopkins RO, et al. The ICM research agenda on intensive care unit-acquired weakness. Intensive Care Med 2017; 43: 1270–81. – reference: 14) Menges D, Seiler B, Tomonaga Y, et al. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care 2021; 25: 16. – reference: 1) Chen X, Liao H, Gao W, et al. Cardiopulmonary bypass duration and the incidence of pressure injuries in patients undergoing cardiovascular surgery: a retrospective cohort study. J Wound Ostomy Continence Nurs 2020; 47: 343–8. – ident: 4 doi: 10.1002/jcsm.12108 – ident: 26 doi: 10.1097/ALN.0000000000000874 – ident: 6 doi: 10.1016/j.jtcvs.2014.06.001 – ident: 11 doi: 10.1097/00003246-198608000-00027 – ident: 29 doi: 10.1161/CIRCULATIONAHA.115.016801 – ident: 7 doi: 10.1186/cc13050 – ident: 12 doi: 10.1007/s00134-020-05944-4 – ident: 10 doi: 10.1067/mhl.2002.124554 – ident: 25 doi: 10.1002/jpen.1451 – ident: 3 doi: 10.1164/rccm.201411-2011ST – ident: 27 doi: 10.1002/mus.27248 – ident: 22 – ident: 30 doi: 10.1186/1471-2105-11-453 – ident: 8 doi: 10.1186/s13613-019-0531-x – ident: 17 doi: 10.1007/s00134-017-4757-5 – ident: 28 doi: 10.1186/s13054-016-1403-5 – ident: 16 doi: 10.1056/NEJMc1406274 – ident: 21 doi: 10.1016/S1010-7940(99)00134-7 – ident: 15 doi: 10.3389/fmed.2020.559789 – ident: 2 doi: 10.1371/journal.pone.0223185 – ident: 13 doi: 10.1186/s13054-021-03827-8 – ident: 20 doi: 10.5152/TJAR.2018.44365 – ident: 24 doi: 10.1113/jphysiol.2014.279406 – ident: 1 doi: 10.1097/WON.0000000000000655 – ident: 19 doi: 10.1152/physrev.00028.2014 – ident: 9 doi: 10.3109/09638288809164105 – ident: 14 doi: 10.1186/s13054-020-03446-9 – ident: 23 doi: 10.2147/IJGM.S102819 – ident: 5 doi: 10.1186/cc13052 – ident: 18 doi: 10.1016/j.athoracsur.2014.07.070 |
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| Snippet | Purpose: Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain... Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We... |
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| SubjectTerms | cardiopulmonary bypass Cardiopulmonary Bypass - adverse effects circulation Critical Care Humans intensive care unit-acquired weakness Lactates nomogram Nomograms Original Prospective Studies risk factor Risk Factors Treatment Outcome |
| Title | A Predictive Nomogram for Intensive Care-Acquired Weakness after Cardiopulmonary Bypass |
| URI | https://www.jstage.jst.go.jp/article/atcs/30/1/30_oa.23-00029/_article/-char/en https://www.ncbi.nlm.nih.gov/pubmed/37460303 https://www.proquest.com/docview/2839250129 https://pubmed.ncbi.nlm.nih.gov/PMC10851444 |
| Volume | 30 |
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| ispartofPNX | Annals of Thoracic and Cardiovascular Surgery, 2024/01/25, Vol.30(1), pp.oa.23-00029 |
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