Functional outcome and muscle wasting in adults with tetanus

Abstract

Background: In many countries, in-hospital survival from tetanus is increasing, but long-term outcome is unknown. In high-income settings, critical illness is associated with muscle wasting and poor functional outcome, but there are few data from resource-limited settings. In this study we aimed to assess muscle wasting and long-term functional outcome in adults with tetanus.

Methods: In a prospective observational study involving 80 adults with tetanus, sequential rectus femoris ultrasound measurements were made at admission, 7 days, 14 days and hospital discharge. Functional outcome was assessed at hospital discharge using the Timed Up and Go test, Clinical Frailty Score, Barthel Index and RAND 36-item Short Form Health Survey (SF-36) and 3 and 6 months after discharge using the SF-36 and Barthel Index.

Results: Significant muscle wasting occurred between hospital admission and discharge (p<0.01), particularly in severe disease, where a median 23.49% (interquartile range 10.01-26.07) reduction in rectus femoris cross-sectional area occurred in those with severe (Ablett grades 3 and 4) disease. Muscle mass at discharge was related to objective and subjective measures of physical and emotional function at discharge and 3 and 6 months after discharge. In patients >70 y of age, functional recovery at 6 months was reduced compared with younger patients. Hospital-acquired infection and age were risk factors for muscle wasting.

Conclusions: Significant muscle wasting during hospitalization occurred in patients with tetanus, the extent of which correlates with functional outcome.

Keywords: functional outcome; hospital-acquired infection; muscle mass.

Figure 1.

Median (95% confidence interval) change in RF-CSA (CSA) compared with baseline according to Ablett severity. Ablett grades 1 and 2: mild disease with spasms not interfering with respiration; Ablett grades 3 and 4: severe disease with spasms interfering with respiration with or without autonomic nervous system dysfunction.

Figure 2.

SF-36 scores at hospital discharge (red line) and 3 months (green) and 6 months (blue) after discharge. The figure shows different domains: physical functioning, bodily pain, role limitations due to physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, general health perceptions and single-item perceived change in health. The left panel shows scores in those <70 y of age and the right panel shows scores in those ≥70 y of age.