Risk factors for ICU-acquired weakness in patients undergoing mechanical ventilation: a systematic review and meta-analysis.

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.