Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Outcomes of ICU Patients With a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis

Kelmenson, Daniel A. MD1,2; Held, Natalie MD3; Allen, Richard R. MS1,4; Quan, Dianna MD5; Burnham, Ellen L. MD1,2; Clark, Brendan J. MD, MS1,2; Ho, P. Michael MD, PhD1,6; Kiser, Tyree H. PharmD1,7; Vandivier, R. William MD1,2; Moss, Marc MD1,2

doi: 10.1097/CCM.0000000000002763
Clinical Investigations
Buy
SDC

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.

1Colorado Pulmonary Outcomes Research Group, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.

2Division of Pulmonary Sciences & Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.

3Department of Medicine, University of Colorado School of Medicine, Aurora, CO.

4Peak Statistical Services, Evergreen, CO.

5Department of Neurology, University of Colorado School of Medicine, Aurora, CO.

6Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.

7Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO.

This work was performed at University of Colorado School of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Kelmenson, Quan, and Burnham received support for article research from the National Institutes of Health (NIH). Dr. Quan’s institution received funding from the NIH, Pfizer, and Alnylam (clinical research), and she received funding from Alnylam (speaker payment), Cytokinetics, WebMD (royalties), and UptoDate (royalties). Dr. Kiser’s institution received funding from Allergan and Astellas. Dr. Moss’ institution received funding from NIH/National Heart, Lung, and Blood Institute, K24 HL089223 and R01 NR011051. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Daniel A. Kelmenson, MD, Colorado Pulmonary Outcomes Research Group and Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado School of Medicine, RM 9023, Mail Stop C272, 12700 East 19th Avenue, Aurora, CO 80045. E-mail: Dkelmenson@gmail.com

Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.