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. 2018 Apr;6(7):115.
doi: 10.21037/atm.2018.01.30.

No association between systemic complement activation and intensive care unit-acquired weakness

Esther Witteveen  1   2   3 , Luuk Wieske  1   2   3 , Friso M de Beer  1   2 , Nicole P Juffermans  1   2 , Camiel Verhamme  3 , Marcus J Schultz  1   2 , Ivo N van Schaik  3 , Janneke Horn  1   2 ; BASIC study group
Affiliations

No association between systemic complement activation and intensive care unit-acquired weakness

Esther Witteveen et al. Ann Transl Med. 2018 Apr.

Abstract

Background: The main risk factors for intensive care unit-acquired weakness (ICU-AW) are sepsis, the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction. These risk factors are associated with systemic complement activation. We hypothesized that critically ill patients who develop ICU-AW have increased systemic complement activation compared to critically ill patients who do not develop ICU-AW.

Methods: Complement activation products C3b/c, C4b/c and C5a were measured in plasma of ICU patients with mechanical ventilation for ≥48 hours. Samples were collected at admission to the ICU and for 6 consecutive days. ICU-AW was defined by a mean Medical Research Council (MRC) score <4. We compared the level of complement activation products between patients who did and who did not develop ICU-AW.

Results: Muscle strength measurements and complement assays were available in 27 ICU patients, of whom 13 patients developed ICU-AW. Increased levels of C4b/c were seen in all patients. Neither admission levels, nor maximum, minimum and mean levels of complement activation products were different between patients who did and did not develop ICU-AW.

Conclusions: Complement activation is seen in critically ill patients, but is not different between patients who did and who did not develop ICU-AW.

Keywords: Complement activation; critical illness myopathy; critical illness polyneuropathy; intensive care unit-acquired weakness (ICU-AW); systemic inflammation.

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Conflict of interest statement

Conflicts of Interest: Prof. IN van Schaik received departmental honoraria for serving on scientific advisory boards and a steering committee for CSL-Behring. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Levels of C3b/c, C4b/c and C5a in patients who developed and did not develop ICU-AW. Levels of C3b/c (A), C4b/c (B) and C5a (C) at admission (day 0) and 6 consecutive ICU days in patients who developed and who did not develop ICU-AW. Data are presented as median with interquartile range for each time point and numbers below the lines represent the number of samples of patients with ICU-AW (upper) and without ICU-AW (lower). Dotted lines (in A and B) represent the reference values. ICU, intensive care unit; ICU-AW, intensive care unit-acquired weakness.
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