Abstract
BackgroundA decrease of small nerve fibers in skin biopsies during the course of critical illness has been demonstrated recently. However, the diagnostic use of skin biopsies in sepsis and its time course is not known.MethodsPatients (n=32) with severe sepsis or septic shock were examined using skin biopsies, neurological examination, nerve conduction studies, and sympathetic skin response in the first week after onset of sepsis, 2 weeks and 4 months later and compared to gender- and age-matched healthy controls.ResultsSkin biopsies at the ankle and thigh revealed a significant decrease of intraepidermal nerve fiber density (IENFD) during the first week of sepsis and 2 weeks later. All patients developed critical illness polyneuropathy (CIP) according to electrophysiological criteria and 11 showed IENFD values lower than the 0.05 quantile. Four patients were biopsied after 4 months and still showed decreased IENFD. Results of nerve conduction studies and IENFD did considerably change over time. No differences for survival time between patients with IEFND lower and larger than 3.5 fibers/mm were found.ConclusionsSkin biopsy is able to detect an impairment of small sensory nerve fibers early in the course of sepsis. However, it may not be suited as a prognostic parameter for survival.Trial registrationGerman Clinical Trials Register, DRKS-ID: DRKS00000642, 12/17/2010Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1241-5) contains supplementary material, which is available to authorized users.
Highlights
A decrease of small nerve fibers in skin biopsies during the course of critical illness has been demonstrated recently
ICU-acquired weakness (ICUAW) may be caused by muscle wasting [5], critical illness polyneuropathy (CIP), critical illness myopathy (CIM), or as in most cases, a combination of CIP and CIM [6]
The demographic data of our study population are presented in Table 1. 313 patients were screened, but in many cases (18 %) the patients’ legal representatives did not approve participation in the study, mainly due to the invasive character of skin biopsy
Summary
A decrease of small nerve fibers in skin biopsies during the course of critical illness has been demonstrated recently. The diagnostic use of skin biopsies in sepsis and its time course is not known. About 70 % of patients with sepsis [7], and up to 100 % of patients with multi-organ failure develop CIP [8], but this may be an overestimation due to use of different diagnostic criteria between studies [9]. CIP and CIM share the major clinical signs comprising symmetric and flaccid weakness of the muscles and the absence of deep tendon reflexes [13]. Nerve conduction studies detect CIP and CIM early during the first week of the disease [14, 15]. Typical signs of CIP and CIM are reduction in the amplitude of compound muscle action potentials, whilst nerve conduction velocity is mainly preserved. In CIP, amplitudes of sensory nerve action potential (SNAP) may be reduced or missing, indicating axonal damage to sensory nerves [16, 17]
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