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Persistent hypoproteinemia is an independent risk factor for critical illness polyneuromyopathy


Critical illness polyneuromyopathy (CIPM) is the leading cause of failure to wean in ICU patients without concomitant cardiorespiratory disease, resulting in a prolonged ICU stay and increased morbidity and mortality.


To estimate the epidemiologic characteristics of CIPM in a general ICU and to investigate the risk factors.

Patients and methods

We prospectively evaluated 474 (323 male/ 151 female, age 55 ± 19 years) consecutive patients from August 2004 to September 2005 who were admitted to a general ICU and stayed for >24 hours. All patients were assigned admission APACHE II (15 ± 19) and SOFA (6 ± 3) scores and were subsequently evaluated for newly developed neuromuscular weakness. We examined muscle strength according to the Medical Research Council scale, deep tendon reflexes, sensory function and muscle wasting. Laboratory values and medical therapy were recorded daily. Other potential causes of new-onset generalized weakness after ICU admission were excluded before the diagnosis of CIPM was established.


Fifty (11%) out of 474 patients developed generalized weakness that met the criteria for CIPM. Patients with CIPM had a higher admission APACHE II score (19 ± 7 vs 14 ± 7, P < 0.001), SOFA score (8 ± 3 vs 6 ± 3, P < 0.001) and a higher mortality rate (30% vs 18%, P < 0.05). Multivariate logistic regression showed that risk factors independently associated with the development of CIPM were the duration of hypoproteinemia and APACHE II score during admission at the ICU. Other factors studied were the SOFA score at admission, use of inotropic and pressor agents, duration of enteral and parenteral nutrition, administration of colistin and the development of ventilator-associated pneumonia.


CIPM has a high incidence in the general ICU population. The severity of illness and persistent hypoproteinemia are associated with an increased risk of the development of CIPM.

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Kritikos, K., Angelopoulos, E., Siafaka, A. et al. Persistent hypoproteinemia is an independent risk factor for critical illness polyneuromyopathy. Crit Care 10 (Suppl 1), P219 (2006).

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