Key result
Day 10 qualitative Heckmatt ultrasound outperforms quantitative greyscale in detecting ICU-AW.
Why the study?
The comparative value of qualitative assessment by the Heckmatt scale versus quantitative greyscale analysis of muscle echogenicity for detecting intensive care unit-acquired weakness was unclear.
Does qualitative assessment by the Heckmatt scale improve the detection of ICU-acquired weakness compared to quantitative greyscale analysis in critically ill patients?
Cohort (n=48)
Single-blind (examiners blinded to clinical/ultrasound results)
No
Does qualitative assessment by the Heckmatt scale improve the detection of ICU-acquired weakness compared to quantitative greyscale analysis in critically ill patients?
Effect estimate: AUC 0.79
Absolute Event Rate: 2.6% vs 2.2%
p-value: p=0.006
Qualitative muscle ultrasound analysis using the Heckmatt scale appears superior to quantitative greyscale analysis for detecting intensive care unit-acquired weakness.
May support qualitative Heckmatt over greyscale ultrasound for ICU-AW detection by day 10; hypothesis-generating in this pilot cohort and needs validation.
Qualitative assessment by the Heckmatt scale (HS) and quantitative greyscale analysis of muscle echogenicity were compared for their value in detecting intensive care unit-acquired weakness (ICU-AW). We performed muscle ultrasound (MUS) of eight skeletal muscles on day 3 and day 10 after ICU admission. We calculated the global mean greyscale score (MGS), the global mean z-score (MZS) and the global mean Heckmatt score (MHS). Longitudinal outcome was defined by the modified Rankin scale (mRS) and Barthel index (BI) after 100 days. In total, 652 ultrasound pictures from 38 critically ill patients (18 with and 20 without ICU-AW) and 10 controls were analyzed. Patients with ICU-AW had a higher MHS on day 10 compared to patients without ICU-AW (2.6 (0.4) vs. 2.2 (0.4), p = 0.006). The MHS was superior to ROC analysis (cut-off: 2.2, AUC: 0.79, p = 0.003, sensitivity 86%, specificity 60%) in detecting ICU-AW compared to MGS and MZS on day 10. The MHS correlated with the Medical Research Council sum score (MRC-SS) (r = −0.45, p = 0.004), the mRS (r = 0.45; p = 0.007) and BI (r = −0.38, p = 0.04) on day 100. Qualitative MUS analysis seems superior to quantitative greyscale analysis of muscle echogenicity for the detection of ICU-AW.
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Klawitter et al. (2022) conducted a cohort in Intensive Care Unit-Acquired Weakness (ICU-AW) (n=48). Qualitative assessment of muscle echogenicity (Heckmatt scale) vs. Quantitative greyscale analysis was evaluated on Global mean Heckmatt score (MHS) on day 10 (AUC 0.79, p=0.006). Qualitative muscle ultrasound analysis using the Heckmatt scale on day 10 was superior to quantitative greyscale analysis in detecting intensive care unit-acquired weakness, with an AUC of 0.79.