Original Article
ICU rehabilitation is associated with reduced long-term mortality from sepsis in patients with low skeletal muscle mass: a case control study
Abstract
Background: It is unclear whether intensive care unit (ICU)-rehabilitation reduces mortality from sepsis in low skeletal muscle mass. We evaluated whether the association of ICU-rehabilitation with mortality from sepsis differs between patients with and without low skeletal muscle mass.
Methods: We retrospectively reviewed 516 patients with sepsis who were admitted to the ICU between June 2011 and August 2017. The skeletal muscle area at the level of the third lumbar vertebra was measured with CT on admission. Patients were divided into two groups (low skeletal muscle mass and non-low skeletal muscle mass), and clinical outcomes were compared in patients treated with ICU-rehabilitation and without ICU-rehabilitation within each subgroup. We used Cox regression to examine factors associated with 1-year mortality in each subgroup.
Results: Low skeletal muscle mass was diagnosed in 421 (81.6%). ICU-rehabilitation was conducted to 51.1% low skeletal muscle mass patients and 54.7% non-low skeletal muscle mass patients. In the low skeletal muscle mass subgroup, in-hospital mortality (26.0% vs. 39.8%, P=0.003) and 6-month mortality (38.6% vs. 51.5%, P=0.008) were lower in the ICU-rehabilitation group. However, there were no differences in the non-low skeletal muscle mass group. In the multivariate analysis, ICU-rehabilitation was independently associated with reduced 1-year mortality in low skeletal muscle mass patients (HR: 0.66, 95% CI: 0.49–0.87, P=0.003), but not in non-low skeletal muscle mass patients.
Conclusions: ICU-rehabilitation was independently associated with reduced 1-year mortality from sepsis among low skeletal muscle mass patients, but not among non-low skeletal muscle mass patients. Therefore, the delayed initiation of ICU-rehabilitation should be avoided, especially in low skeletal muscle mass patients.
Methods: We retrospectively reviewed 516 patients with sepsis who were admitted to the ICU between June 2011 and August 2017. The skeletal muscle area at the level of the third lumbar vertebra was measured with CT on admission. Patients were divided into two groups (low skeletal muscle mass and non-low skeletal muscle mass), and clinical outcomes were compared in patients treated with ICU-rehabilitation and without ICU-rehabilitation within each subgroup. We used Cox regression to examine factors associated with 1-year mortality in each subgroup.
Results: Low skeletal muscle mass was diagnosed in 421 (81.6%). ICU-rehabilitation was conducted to 51.1% low skeletal muscle mass patients and 54.7% non-low skeletal muscle mass patients. In the low skeletal muscle mass subgroup, in-hospital mortality (26.0% vs. 39.8%, P=0.003) and 6-month mortality (38.6% vs. 51.5%, P=0.008) were lower in the ICU-rehabilitation group. However, there were no differences in the non-low skeletal muscle mass group. In the multivariate analysis, ICU-rehabilitation was independently associated with reduced 1-year mortality in low skeletal muscle mass patients (HR: 0.66, 95% CI: 0.49–0.87, P=0.003), but not in non-low skeletal muscle mass patients.
Conclusions: ICU-rehabilitation was independently associated with reduced 1-year mortality from sepsis among low skeletal muscle mass patients, but not among non-low skeletal muscle mass patients. Therefore, the delayed initiation of ICU-rehabilitation should be avoided, especially in low skeletal muscle mass patients.
