Acute Physiology and Chronic Health Evaluation II score of ≥15: A risk factor for sepsis-induced critical illness polyneuropathy.

BACKGROUND Critical illness polyneuropathy (CIP) is a common complication of severe sepsis and systemic inflammatory response syndrome (SIRS). The risk factors for sepsis-induced CIP have not been well established. AIM The aim of this study was to find out the risk factors of sepsis-induced CIP, especially its relationship with the severity of illness. PATIENTS AND METHODS A cohort of 100 patients with sepsis defined as SIRS of proven or presumed microbial etiology were followed up with nerve conduction studies (NCS) performed within the first 14 days of admission. If the assessment was normal then the study was repeated between day 21 and 28. The two groups (with and without neuropathy) were compared. The following risk factors were evaluated for the development of sepsis-related CIP: Duration of symptoms, stay in Intensive Care Unit, and mechanical ventilation; use of neuromuscular blocking agents (NMBAs), steroids, insulin infusion, and inotropes. The following laboratory parameters recorded in the first 24 h of admission were included: Hemoglobin (Hb), total leukocyte count, serum urea, creatinine, aminotransaminases (aspartate aminotransferase and alanine aminotransferase), total protein, albumin, potassium, creatinine kinase, plasma glucose, HbA1C, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission or within 24 h. RESULTS Thirty-seven patients had features of neuropathy. Among these 37 patients, 30 patients (81%) developed it in the first 14 days. Multivariate analysis using linear regression showed the APACHE II score and use of NMBAs to be significant factors in its development. An APACHE II score of ≥15 was associated with a significant risk of developing CIP (relative risk: 11.6, 95% confidence interval: 4.9-27.2, P < 0.0001). CONCLUSION Critically ill patients with sepsis and APACHE II score at admission or within 24 h of ≥15 are at risk for the development of CIP.