Critical Care

, 19:P472 | Cite as

Increased early systemic inflammation in patients with ICU-acquired weakness

  • E Witteveen
  • L Wieske
  • C Verhamme
  • T Van der Poll
  • IN Van Schaik
  • MJ Schultz
  • J Horn
Open Access
Poster presentation
  • 344 Downloads

Keywords

Systemic Inflammation Main Risk Factor Multivariable Logistic Regression Model Sofa Score Cytometric Bead Array 

Introduction

Inflammation may be important in the pathogenesis of ICU-acquired weakness (ICU-AW) since SIRS, sepsis and multiple organ failure are the main risk factors. Local inflammation has been found in muscle and nerve tissue of patients with ICU-AW, but little is known about the association with systemic inflammation. We hypothesized that systemic inflammation is increased in patients who develop ICUAW compared with patients who do not develop ICU-AW.

Methods

Newly admitted ICU patients ≥48 hours on mechanical ventilation were included. Daily plasma samples were collected from leftover plasma. Muscle strength was evaluated as soon as patients were awake and attentive. ICU-AW was defined by a mean Medical Research Council score <4. IL-1β, IL-6, IL-8, IL-10, IL-13, TNFα, IFNγ, fractalkine, GM-CSF, sICAM-1, sE-selectin and sP-selectin were measured in plasma samples of days 0, 2 and 4 using cytometric bead arrays and FACS. Differences of maximum levels between patients with and without ICUAW were calculated using Mann-Whitney U tests. Principal component (PC) analysis was used to avoid multicollinearity and to reduce the set of mediators into a smaller set of PCs. To investigate whether different inflammatory profiles are associated with development of ICU-AW, we used multivariable logistic regression models of selected PCs, corrected for a priori selected variables, being age, gender, BMI, sepsis, SOFA score, APACHE IV score, immune insufficiency and corticosteroids.

Results

Ninety-nine of 204 included patients developed ICU-AW. Patients with ICU-AW had higher APACHE IV and SOFA scores, a longer duration of mechanical ventilation, longer ICU stay, and died more often on the ICU compared with ICU patients without ICU-AW. Maximal levels of IL-1β, IL-6, IL-8, IL-10, TNFα, IFNγ, fractalkine and sICAM-1 were higher in patients who developed ICU-AW compared with patients who did not develop ICU-AW (univariable analysis). PC 1 to 4 derived from maximal levels explained >69% of the total variance in the data. Multivariable logistic regression models showed that PC 1 (mainly loaded by IL-6, IL-8 and IL-10) and PC 4 (mainly loaded by sP-selectin) were significantly higher in patients with ICU-AW compared with patients without ICU-AW (OR of 1.27 (95% CI = 1.02 to 1.60) and 1.55 (1.06 to 2.27) respectively).

Conclusion

Development of ICU-AW is associated with increased systemic inflammation in the first days after ICU admission.

Acknowledgement

This research was supported by the Center for Translational Molecular Medicine (MARS).

Copyright information

© Witteveen et al.; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • E Witteveen
    • 1
  • L Wieske
    • 1
  • C Verhamme
    • 1
  • T Van der Poll
    • 1
  • IN Van Schaik
    • 1
  • MJ Schultz
    • 1
  • J Horn
    • 1
  1. 1.Academic Medical CenterAmsterdamthe Netherlands

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