Sepsis-induced neuromuscular dysfunction: A systematic review with meta-analysis

Sepsis-induced neuromuscular dysfunction (SIND) is a common but underrecognized complication in critically ill patients, contributing to prolonged intensive care unit (ICU) stays, increased morbidity, and long-term functional impairment. Its pathophysiology is multifactorial, involving interactions among host factors, disease severity, and therapeutic interventions.

To systematically identify and classify risk factors associated with SIND in septic patients and to estimate its pooled prevalence across clinical studies.

A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42024577234). Databases; Medline, BMC, Cochrane Library, and Google Scholar, were searched for relevant studies. Fourteen studies including 596 adult patients with sepsis were eligible. Risk factors were categorized into seven clinical domains and further stratified as modifiable or non-modifiable. Pooled prevalence estimates were calculated using a random-effects model (DerSimonian-Laird method).

A total of 40 clinical parameters were identified and grouped into seven categories: baseline characteristics, organ failure, disease severity indices, medical procedures, plasma biomarkers, pharmacological therapy, and length of stay. The pooled prevalence of SIND was 60% (95% CI: 50-70%), with substantial heterogeneity. ICU-acquired neuromuscular dysfunction showed a prevalence of 70% (95% CI: 60-80%), whereas direct neuromuscular damage attributable to sepsis was lower (9%, 95% CI: 4-19%). Critical illness polyneuropathy was the most frequently reported entity and demonstrated strong associations with both modifiable and non-modifiable risk factors.

SIND is a highly prevalent and multifactorial complication of sepsis. Early recognition of risk factors-particularly modifiable ones-may support targeted preventive strategies and improve clinical outcomes in critically ill patients.