Wu Yuchen, Liu Yatao, Wang Guoqiang, Zheng Ang, Zhang Zhigang, Wei Huaping, Wang Xin
Research Institution, China Medical University, Shenyang, China.
Department of Anesthesiology and Operating Theater, The First Hospital of Lanzhou University, Lanzhou, China.
Nurs Crit Care. 2025 May;30(3):e70018. doi: 10.1111/nicc.70018.
The Chelsea Critical Care Physical Assessment Tool (CPAx) may be an optimal tool for diagnosing intensive care unit-acquired weakness (ICU-AW). However, we do not know the cut-off point for the diagnosis of ICU-AW.
To ascertain the best cut-off point for CPAx to diagnose ICU-AW in adult patients with mechanical ventilation.
A multicentre, prospective cross-sectional study. Participants were recruited from five ICUs in China that ranged from 20 June 2021 to 31 July 2023. The Medical Research Council Sum Scale (MRC-ss) <48 was taken as the standard to calculate the area under the curve (AUC) of CPAx. The cut-off point was determined by the maximum value of Youden Index (YI). The kappa (κ) test was used to test the consistency of the MRC-ss and CPAx.
The AUC at baseline, weaning and discharge time point was 0.87 (95% CI 0.81-0.93), 0.96 (95% CI 0.92-0.99) and 0.91 (95% CI 0.86-0.96), respectively. Correspondingly, The YImax was 0.62, 0.91 and 0.65. The best cut-off point of CPAx score to diagnose ICU-AW at baseline, weaning and discharge time point was 30.5 (sensitivity = 72%, specificity = 89%), 31.5 (sensitivity = 95%, specificity = 90%) and 31.5 (sensitivity = 94%, specificity = 71%), respectively. Due to the CPAx being an ordinal scale, it was determined preliminarily that the cut-off point for the CPAx to diagnose ICU-AW was 31 points. We took CPAx ≤31 and MRC-ss <48 as criteria to diagnose ICU-AW and test the consistency of MRC-ss and CPAx. The results showed that there was no significant difference in the incidence of ICU-AW at different time points.
The optimal cut-off point for the CPAx to diagnose ICU-AW is a score of 31 and it has good sensitivity and specificity.
The CPAx ≤31 score to diagnose ICU-acquired weakness (ICU-AW) has good sensitivity and specificity, and it can help to predict the risk of ICU-AW and guide medical personnel to make interventions.
切尔西重症监护物理评估工具（CPAx）可能是诊断重症监护病房获得性肌无力（ICU-AW）的最佳工具。然而，我们尚不清楚诊断ICU-AW的临界点。
确定CPAx诊断机械通气成年患者ICU-AW的最佳临界点。
一项多中心、前瞻性横断面研究。研究对象于2021年6月20日至2023年7月31日从中国的5个重症监护病房招募。以医学研究委员会总评分量表（MRC-ss）<48分为标准计算CPAx的曲线下面积（AUC）。通过约登指数（YI）的最大值确定临界点。采用kappa（κ）检验来检验MRC-ss与CPAx的一致性。
基线、撤机和出院时间点的AUC分别为0.87（95%可信区间0.81-0.93）、0.96（95%可信区间0.92-0.99）和0.91（95%可信区间0.86-0.96）。相应地，YImax分别为0.62、0.91和0.65。CPAx评分在基线、撤机和出院时间点诊断ICU-AW的最佳临界点分别为30.5（敏感性=72%，特异性=89%）、31.5（敏感性=95%，特异性=90%）和31.5（敏感性=94%，特异性=71%）。由于CPAx为有序量表，初步确定CPAx诊断ICU-AW的临界点为31分。我们以CPAx≤31分和MRC-ss<48分为标准诊断ICU-AW，并检验MRC-ss与CPAx的一致性。结果显示，不同时间点ICU-AW的发生率无显著差异。
CPAx诊断ICU-AW的最佳临界点为31分，且具有良好的敏感性和特异性。
CPAx≤31分诊断重症监护病房获得性肌无力（ICU-AW）具有良好的敏感性和特异性，有助于预测ICU-AW风险并指导医务人员进行干预。
