Outcomes of ICU Patients With a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis. Issue 12 (December 2017)

• Record Type: Journal Article
• Authors: Kelmenson, Daniel A.; Held, Natalie; Allen, Richard R.; Quan, Dianna; Burnham, Ellen L.; Clark, Brendan J.; Ho, P. Michael; Kiser, Tyree H.; Vandivier, R. William; Moss, Marc
• Is Part Of: Critical care medicine. Volume 45:Issue 12(2017)
• Publication Date: 2017-12
• Subjects: critical care -- critical care outcomes -- critical illness -- muscle weakness -- polyneuropathies; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002763
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objectives: To assess the impact of a discharge diagnosis of critical illness polyneuromyopathy on health-related outcomes in a large cohort of patients requiring ICU admission. Design: Retrospective cohort with propensity score–matched analysis. Setting: Analysis of a large multihospital database. Patients: Adult ICU patients without preexisting neuromuscular abnormalities and a discharge diagnosis of critical illness polyneuropathy and/or myopathy along with adult ICU propensity-matched control patients. Interventions: None. Measurements and Main Results: Of 3, 567 ICU patients with a discharge diagnosis of critical illness polyneuropathy and/or myopathy, we matched 3, 436 of these patients to 3, 436 ICU patients who did not have a discharge diagnosis of critical illness polyneuropathy and/or myopathy. After propensity matching and adjusting for unbalanced covariates, we used conditional logistic regression and a repeated measures model to compare patient outcomes. Compared to patients without a discharge diagnosis of critical illness polyneuropathy and/or myopathy, patients with a discharge diagnosis of critical illness polyneuropathy and/or myopathy had fewer 28-day hospital-free days (6 [0.1] vs 7.4 [0.1] d; p < 0.0001), had fewer 28-day ventilator-free days (15.7 [0.2] vs 17.5 [0.2] d; p < 0.0001), had higher hospitalization charges (313, 508 [4, 853] vs 256, 288 [4, 470] dollars; p < 0.0001), and were less likely to be discharged home (15.3% vs 32.8%; p < 0.0001) but had lower in-hospital mortality (13.7% vs 18.3%; p < 0.0001). Conclusions: In a propensity-matched analysis of a large national database, a discharge diagnosis of critical illness polyneuropathy and/or myopathy is strongly associated with deleterious outcomes including fewer hospital-free days, fewer ventilator-free days, higher hospital charges, and reduced discharge home but also an unexpectedly lower in-hospital mortality. This study demonstrates the clinical importance of a discharge diagnosis of critical illness polyneuropathy and/or myopathy and the need for effective preventive interventions. Abstract : Supplemental Digital Content is available in the text.