الفهرس 
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Abstract
Summary
Skeletal muscle weakness is one of the major risk factors associated with increased length of stay in intensive care units (ICUs) and hospitals, as well as in-hospital mortality and physical disability. Patients who are critically ill with sepsis are at risk of developing muscle wasting. However, accurate quantification of muscle wasting among these patients remains a challenge.
The aim of the present study was to find out the feasibility of using muscle ultrasound as a diagnostic and assessment tool of myopathy in critically ill patients with sepsis.
This study was case controlled study, it enrolled patients’ group: 40patients diagnosed as having sepsis or septic shock. Sepsis and septic shock was defined according to Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) as life-threatening organ dysfunction caused by a dysregulated host response to infection, Organ dysfunction can be identified as an acute change in total Sequential Organ Failure Assessment (SOFA) Score≥2 points consequent to the infection.
In addition, control patients: 25 patients of comparable age with no sepsis criteria will undergo clinical neurological evaluation and muscle ultrasound will be serving as a control to the study.
All patients included in the study was subjected to: History taking, Full clinical assessment: including general and neurological examination between day 2 and 5 and between day 10 and15 after the onset of severe sepsis or septic shock, respectively, Routine laboratory investigations, Muscle ultrasound to all patients between days 2 and 5 and day 10 and15 after the onset of severe sepsis or septic shock, respectively, Nerve conduction studies and Electromyography
MRC score evaluation showed that there was a significant decrease in muscle strength between first and second evaluation in both patients and control groups but was more significant in the patients’ group, while the reflexes affection was prominent only in the patients group.
Regarding ultrasound evaluation there was a significant decrease in muscle echo intensity and fasciculations between first and second evaluation in patients and between patients and control group while there was non-significant decrease in muscle echo intensity and fasciculations between first and second evaluation in in the control group.
Also in NCS study there was a significant affection by neuropathy in most examined nerves between first and second evaluation in patients. The same was found with EMG muscle examination as there was significant myopathy in most examined muscle groups in 2nd evaluation in comparison to 1st evaluation.
The Relation between muscle ultrasound findings and positive findings of NCS in 1st evaluation showing high sensitivity 100% with in upper and lower limbs, with specificity was (50 - 62%). However, in the 2nd evaluation the sensitivity (80- 82%) in upper limbs and (100%) in lower limbs with. The specificity was low (20-23%) in upper limbs.
While the relation between positive ultrasound findings and positive findings of electromyography study in 1st evaluation in the test group was showing high sensitivity (100%) in ultrasound results except in right upper limb where the sensitivity was 50%. The specificity was 50 % with NPV (80-100 %). In 2nd evaluation in the patients test group, increased sensitivity between (75 -100%) in ultrasound results.
In addition, the relation with positive findings in both nerve conduction study and electromyography study: showed positive presence of neuropathy and myopathy in 1st evaluation in the test group showing high sensitivity (100%) in ultrasound results except in right upper limb where the sensitivity was not applicable (there was no positive patients). The specificity was between (42.9-50 %). In 2nd evaluation in the test group, increased sensitivity was (80-100%) in ultrasound results.
The muscle echogenicity on day 14 was the best diagnostic tool for neuromyopathy in critical ill patients at the cut off point for biceps and extensor ultrasound score >1.5, and for Quadriceps and tibialis it was found to be >2.