Risk factors for ICU-acquired weakness in patients undergoing mechanical
ventilation: a systematic review and meta-analysis
#MMPMID41229757
Zhao M
; Fan Y
; Wu T
; Yu L
; Li H
; Zeng H
; Wu Y
J Thorac Dis
2025[Oct]; 17
(10
): 8497-8510
PMID41229757
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BACKGROUND: Intensive care unit (ICU)-acquired weakness (ICU-AW) commonly occurs
in mechanical ventilation (MV) patients and is associated with prolonged
ventilation, longer ICU stay, and poorer functional outcomes. Evidence regarding
the association between corticosteroid (CS) exposure and ICU-AW is inconsistent,
and the contribution of other clinical factors is unclear. This study aimed to
examine the risk factors connected to the development of ICU-AW related to CS use
in patients undergoing MV in the ICU. METHODS: A systematic search in multiple
databases, including PubMed, Web of Science, Embase, Cochrane Library, China
National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and the
Chinese Biomedical Literature Database (CBM) was conducted up to December 2024.
The Newcastle-Ottawa Scale (NOS) was leveraged to appraise cohort study quality,
while Revised Cochrane Risk-of-Bias Tool for Randomized Trials (ROB2) was applied
for randomized controlled trials (RCTs). The meta-analysis was implemented by
means of Stata 16 software. RESULTS: Finally, 2 RCTs and 19 cohort studies were
incorporated, involving 6,894 patients. The meta-analysis suggested that CS use
was significantly associated with an increased incidence of ICU-acquired weakness
among MV patients [risk ratio (RR) =1.52, 95% confidence interval (CI):
1.31-1.76, P<0.001]. Patients undergoing MV exhibited a higher likelihood of
developing ICU-AW in the presence of several risk factors, including prolonged MV
duration, advanced age, high-dose and long-term use of CS, elevated blood glucose
levels, increased lactate levels, higher APACHE II scores, elevated body mass
index (BMI), and extended length of stay (LOS) in the ICU. CONCLUSIONS: In the
ICU, CS use is significantly associated with the risk of ICU-AW, particularly in
patients who have the following characteristics: MV duration ?8 days, age ?60
years, long-term high-dose CS use (?1 g), CS use for more than 7 days,
hyperglycemia (>13 mmol/L), elevated lactate levels (?4 mmol/L), an APACHE II
score ?19, a BMI ?24 kg/m2, and a LOS in the ICU exceeding 14 days. SYSTEMATIC
REVIEW REGISTRATION: http://www.crd.york.ac.uk/prospero/PROSPERO; Registration
Number: CRD42024558263.
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