Gu Bin, Zhou Yu, Shi Rui, Miao Shumin, Pei Fei, Yuan Hao, Wang Luhao, Teboul Jean-Louis, Si Xiang, Guan Xiangdong, Wu Jianfeng
Therapeutics and Intensive Care Medicine, Paris-Saclay University Hospitals, Paris-Saclay University, Paris, France.
Shock. 2025 Jan 1;63(1):19-29. doi: 10.1097/SHK.0000000000002484. Epub 2024 Oct 2.
Background : This systematic review and meta-analysis aims to detecting performance of muscular ultrasound for intensive care unit (ICU)-acquired weakness (ICUAW). Methods : We searched PubMed, Web of Science, Embase, Cochrane library, CNKI, VIP, and Wanfang databases for articles published before July 2024. A random-effects model was utilized to derive the summary estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI). Additionally, the sources of heterogeneity were explored by subgroup analysis and meta-regression. Results : This meta-analysis comprised 10 prospective studies involving 561 participants, of whom 241 (42.96%) were diagnosed as ICUAW. Overall, muscular ultrasound exhibited good performance for detecting ICUAW, with the area of summary receiver operating characteristic (SROC) curve of 0.85 (95%CI 0.82-0.88), sensitivity of 0.76 (95%CI 0.70-0.81), specificity of 0.80 (95%CI 0.74-0.84), and DOR of 12.43 (95%CI 7.98-19.38). Upon predefined subgroup analysis, the rectus femoris exhibited significantly superior discriminatory ability in identifying ICUAW than the non-rectus femoris, with higher SROC (0.88 [95%CI 0.85-0.91] vs. 0.76 [95%CI 0.72-0.79], P < 0.01). Moreover, cross-sectional area was more effective than thickness, with higher specificity (0.86 [95%CI 0.80-0.91] vs. 0.74 [95%CI 0.68-0.79], P = 0.02) and SROC (0.89 [95%CI 0.86-0.92] vs. 0.76 [95%CI 0.72-0.80], P < 0.01). Furthermore, integrated analysis of these two indicators revealed that the cross-sectional area of rectus femoris was statistically superior to the thickness of rectus femoris, with higher sensitivity (0.82 [95%CI 0.74-0.87] vs. 0.75 [95%CI 0.65-0.83], P < 0.05) and AUC (0.91 [95%CI 0.88-0.93] vs. 0.80 [95%CI 0.76-0.83], P < 0.01). Conclusions : Muscular ultrasound could be a reliable tool for ICUAW detection. Compared with alternative indices, the cross-sectional area of the rectus femoris exhibits superior detection efficacy and may be considered as a valuable parameter for clinical application.
本系统评价和荟萃分析旨在检测肌肉超声在重症监护病房（ICU）获得性肌无力（ICUAW）中的诊断性能。方法：我们检索了截至2024年7月发表在PubMed、Web of Science、Embase、Cochrane图书馆、中国知网、维普和万方数据库中的文章。采用随机效应模型得出敏感度、特异度和诊断比值比（DOR）的汇总估计值，并给出95%置信区间（CI）。此外，通过亚组分析和Meta回归探索异质性来源。结果：该荟萃分析纳入了10项前瞻性研究，共561名参与者，其中241名（42.96%）被诊断为ICUAW。总体而言，肌肉超声在检测ICUAW方面表现良好，汇总受试者工作特征（SROC）曲线面积为0.85（95%CI 0.82-0.88），敏感度为0.76（95%CI 0.70-0.81），特异度为0.80（95%CI 0.74-0.84），DOR为12.43（95%CI 7.98-19.38）。在预定义的亚组分析中，股直肌在识别ICUAW方面的鉴别能力明显优于非股直肌，SROC更高（0.88[95%CI 0.85-0.91]对0.76[95%CI 0.72-0.79]，P<0.01）。此外，横截面积比厚度更有效，特异度更高（0.86[95%CI 0.80-0.91]对0.74[95%CI 0.68-0.79]，P = 0.02），SROC也更高（0.89[95%CI 0.86-0.92]对0.76[95%CI 0.72-0.80]，P<0.01）。此外，对这两个指标的综合分析显示，股直肌的横截面积在统计学上优于股直肌的厚度，敏感度更高（0.82[95%CI 0.74-0.87]对0.75[95%CI 0.65-0.83]，P<0.05），曲线下面积（AUC）也更高（0.91[95%CI 0.88-0.93]对0.80[95%CI 0.76-0.83]，P<0.01）。结论：肌肉超声可能是检测ICUAW的可靠工具。与其他指标相比，股直肌的横截面积具有更高的检测效能，可作为临床应用的有价值参数。
