Comparison of rehabilitation practices between sepsis and non sepsis patients during Intensive care hospitalization in cancer patients: a retrospective cohort study

Comparison of rehabilitation practices between sepsis and non sepsis patients during Intensive care hospitalization in cancer patients: a retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of rehabilitation practices between sepsis and non sepsis patients during Intensive care hospitalization in cancer patients: a retrospective cohort study Chen Gao, Zhen Zhang, Yang Lyu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7025660/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : Long-term outcomes of cancer patients with sepsis have garnered increasing attention, especially in severe rehabilitation. This study aims to explore the improvements in comprehensive motor ability and muscle strength through early rehabilitation treatment in cancer patients with sepsis. Method : A total of 171 cancer patients were included in this retrospective study. Muscle strength and motor ability were assessed using Medical Research Council score (MRC-SS) and Chelsea Critical Care Physical Assessment Tool (CPAx)；Wilcoxon signed-rank and Mann-Whitney U tests were used to assess improvements after rehabilitation as well as the differences between groups. Results : 1. Patients in the sepsis group exhibited slightly lower CPAx scores compared to the non sepsis group (z=-3.002, P =0.003). After early rehabilitation treatment, the CPAx scores were improved from 35 (IQR 33, 37) to 40 (IQR 38, 42), with significant differences observed in statistical analysis ( P <0.05); The MRC-SS scores were improved from 56 (IQR54, 56) to 56 (IQR56, 58), but the overall muscle strength score was slightly lower than that of non sepsis patients (z=-2.198, P <0.05). 2. Five patients were diagnosed with ICU-acquired weakness (ICU-AW), all of whom were sepsis patients multiple risk factors. Early rehabilitation did not yield significant improvements in muscle strength or motor ability in this subgroup. Conclusion : Early rehabilitation is essential for patients with sepsis to enhance motor activity and provide them a tangible sense of recovery. At the same time, the challenges of rehabilitation for critically ill patients with overlapping risks were also emphasized. Cancer Sepsis ICU-acquired weakness Rehabilitation Critical care practice Figures Figure 1 1 Introduction The global burden of cancer incidence was rapidly growing, and cancer patients were more likely to be immunocompromised due to malignancy itself, recent surgical interventions, or chemotherapy, making them more vulnerable to severe infections[ 1 , 2 ], with sepsis being the most common reason for intensive care unit (ICU) admission. Given the high risk of complications and poor outcomes in patients with sepsis, which is an independent risk factor for ICU-acquired weakness (ICU-AW)[ 3 , 4 ], it is important to explore whether early physical rehabilitation can support better long-term outcomes without exacerbating risks. ICU-AW is definded as an acute neuromuscular injury caused by critical illness, clinically characterized by limb and respiratory muscle weakness in clinical manifestation. It is a severe complication that can lead to prolonged mechanical ventilation, longer hospital stays, reduced quality of life after discharge, and substantially educed long-term survival rates for patients[ 5 , 6 ]. However, there is still insufficient understanding of ICU-AW in current clinical practice. Due to the lack of clear clinical features in the early stages of the disease, the implementation of rehabilitation intervention strategies were often delayed. The widely accepted clinical criteria for ICU-AW is manual muscle test, also known as the Medical Research Council score (MRC-SS). When symmetrical delayed weakness occurs (assuming intact cranial nerve function during ICU hospitalization) and the total score of both MRC-SS tests is below 48 points, with an evaluation interval of more than 24 hours, ICU-AW can be diagnosed[ 7 , 8 ]. The limitation is that the MRC-SS scale cannot evaluate the respiratory and motor functions, while the Chelsea Critical Care Physical Assessment Tool (CPAx) covered ten functions of patients from supine to sitting, breathing, coughing, standing, walking, etc., reflecting their comprehensive motor ability and functional independence, and focusing on multidimensional assessment of motor activities [ 9 – 11 ]. “Early mobility and exercise” (i.e. element E) was considered by Lang et al. as key elements in the ICU adult management guidelines published by the Society of Critical Care Medicine (SCCM) in the United State[ 12 , 13 ]. In this study, we used the CPAx and MRC-SS scale to evaluate improvements in functional mobility and muscle strength among sepsis patients receiving early rehabilitation, in order to demonstrate the importance of early rehabilitation in preventing ICU-AW. 2 Object and method 2.1 Subjects: Inclusion criteria: Cancer patients admitted to the ICU who have undergone a joint assessment by both rehabilitation physicians and supervising physicians, and whose condition is deemed relatively stable, are eligible for early rehabilitation training. Exclusion criteria: They have pre-existing limb movement disorders caused by cerebrovascular or orthopedic diseases, that is, limb movement disorders present prior to ICU admission. According to the diagnostic criteria for sepsis in the third international consensus on the definition of sepsis and septic shock (Sepsis-3.0) released by the European Society for Critical Care Medicine in 2016[ 14 ]; The experimental group consists of patients diagnosed with sepsis, while the control group consists of non sepsis patients. This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The ethical approval was given by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital with the following reference numbers:bc20251076. 2.2 Methods: The patient underwent evaluations using the MRC-SS and CPAx within 48 hours of being transferred to ICU. A reassessment of MRC-SS and CPAx was performed prior to ICU discharge. Rehabilitation training was conducted twice daily, with each session lasting 20 to 30 minutes. The training was categorized into three types based on patient positioning: ① active and passive upper and lower limb exercises performed in a semi-recumbent position on the bed. ② Active upper and lower limb exercises performed in a legged sitting position on the bed. ③Active upper and lower limb exercises performed in a sitting or standing position beside the bed. All training sessions were combined with respiratory exercises, including abdominal breathing, pursed-lip breathing, and assisted coughing and sputum clearance. Patients demographics and laboratory indicators were collected, including age and gender, SOFA and APACHE II scores, blood routine white blood cell count (WBC); Albumin (ALB); Hemoglobin (Hb); Lactic acid (La); Blood urea nitrogen (BUN), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP); D-dimer (D-D). 2.3 Statistical analysis: SPSS 19.0 software was used for data processing. After normality testing, normally distributed data are represented by mean ± standard deviation (x ± s), while non normally distributed data are expressed as median with interquartile ranges; Categorical variables were compared between groups using the chi-square (χ²) test. For continuous variables, independent samples t-test was applied to data with normal distribution, whereas the Mann–Whitney U test was used for non-normally distributed data. Paired sample comparisons between two groups were performed using the Wilcoxon signed-rank test. A p-value of less than 0.05 was considered statistically significant. 3 Results 3.1 Clinical characteristics of sepsis and non sepsis patients A total of 171 cancer patients were included in this study, comprising 118 males (69.01%) and 53 females (30.99%), with an average age of 69.29 ± 9.88 years. Among them, 129 patients were diagnosed with sepsis, of whom 39.53% (51/129) developed septic shock. The proportion of males was significantly higher in the sepsis group compared to the non-sepsis group (χ²=0.053, P < 0.05). As shown in Table 1 , the sepsis group included 93 males (72.09%) and 36 females (27.91%) with an average age of 69.80 ± 9.39 years. The non-sepsis group consisted of 25 males (59.52%) and 17 females (32.69%) with an average age of 67.74 ± 11.24 years. Laboratory indicators such as La, WBC, IL-6, PCT, and CRP were significantly elevated in the sepsis group. Correspondingly, SOFA and APACHE II scores indicated more severe illness in the sepsis group. The CPAx score was slightly lower in the sepsis group (z = -3.002, P = 0.003), whereas no significant difference was observed in MRC-SS between the two groups (z = -1.714, P = 0.087). Table 1 Comparison of Clinical characteristics between ICU Sepsis and Control Group Sepsis (N = 129) Non-sepsis (N = 42) Statistical value P value Gender Male 93 25 0.503 0.019 Female 36 17 Age (x ± s, y.o.) 69.80 (9.39) 67.74 (11.24) 3.167 0.77 SOFA 5.86 (2.83) 3.76 (1.96) 5.354 < 0.001 APACHEⅡ 16.69 (5.18) 14.33 (3.61) 3.276 0.001 CPAx 35 (33, 37) 37 (36, 38) −3.002 0.003 MRC-SS 56 (54, 56) 56 (56, 56) −1.714 0.087 D-LA (mg/L) 2.3 (1.7, 3.2) 1.28 (1.50, 2.10) −4.447 < 0.001 Hb (g/L) 107.97 (24.62) 107.60 (24.81) 0.085 0.932 Albumin (g/L) 32.83 (5.50) 34.55 (4.68) −1.822 0.07 BUN (mmol/L) 9.8 (7.80, 14.4) 10.2 (7.65, 12.90) −0.13 0.99 WBC (×10 9 / L) 13.68 (5.74) 10.78 (6.02) 2.817 0.005 IL-6 (µg/L) 244.30 (122.15, 399.90) 70.63 (38.60, 124.53) −6.804 < 0.001 PCT (µg/L) 1.00 (0.51, 3.13) 0.16 (0.14, 0.21) −8.489 < 0.001 CRP (mg/L) 148.43 (58.20) 44.43 (44.95) 12.060 < 0.001 Note: The data of CPAx Score, MRC-SS, D-lactic acid, Urea nitrogen, Interleukin-6, and Procalcitonin are all non-normally distributed, which are expressed by median and quartile. 3.2 Motor Ability and Muscle Strength in Sepsis Patients Before and After Rehabilitation Following rehabilitation, CPAx scores in sepsis patients improved significantly from a median of 35 (IQR 33, 37) to 40 (IQR 38, 42). This improvement was observed across all ten assessed items: supine-to-sitting, respiration, coughing, sit-to-stand transition, seated balance, in-bed mobility, bed-to-chair transfer, grip strength, walking, and standing (all P < 0.05), as detailed in Table 2 . Post-treatment CPAx scores were comparable between sepsis and non-sepsis patients, with medians of 40 (IQR 38, 42) and 39.5 (IQR 38, 42), respectively (z = -0.287, P = 0.774). Table 2 MRC-SS and CPAx Scores Before and After Rehabilitation Training Group Sepsis(N = 129) Non-sepsis(N = 42) Before After z P value Before After z P value CPAx 35 (33, 37) 40 (38, 42) −8.891 < 0.001 37 (36, 38) 39.5 (38, 42) −5.398 < 0.001 MRC-SS 56 (54, 56) 56 (56, 58) −5.347 < 0.001 56 (56, 56) 58 (56,58) −4.065 < 0.001 Supine to sitting on the edge of the bed 4 ( 3, 4 ) 4 ( 4, 4 ) −7.594 < 0.001 4 (3.75, 4) 4 (4, 5) −4.690 < 0.001 Respiratory function 4 ( 4, 4 ) 4 ( 4, 4 ) −4.147 < 0.001 4 ( 4, 4 ) 4 ( 4, 4 ) −1.000 0.317 Cough 4 ( 4, 4 ) 5 ( 4, 5 ) 6.745 < 0.001 4 ( 4, 4 ) 4 (4, 5) −3.873 < 0.001 Sit - to - stand 3 ( 3, 3 ) 4 ( 3, 4 ) 8.128 < 0.001 3 ( 3, 3 ) 4 ( 3, 4 ) −5.099 < 0.001 Dynamic sitting 5 ( 4, 5 ) 5 ( 5, 5 ) 6.216 < 0.001 5 ( 4 ,5 ) 5 ( 5 ,5 ) −3.000 0.003 Bed mobility 5 (4, 5 ) 5 ( 5, 5 ) 5.786 < 0.001 5 (4.75 ,5 ) 5 ( 5 ,5 ) −2.236 0.025 Transferring from bed to chair 3 ( 3, 3 ) 4 ( 3, 4 ) 6.736 < 0.001 3 ( 3, 3 ) 4 ( 3, 4 ) −4.243 < 0.001 Grip strength 3 ( 3, 3 ) 3 ( 3, 3 ) 3.130 0.002 3 ( 3, 3 ) 3 ( 3, 3 ) −1.000 0.317 Stepping 3 ( 3, 3 ) 4 ( 3, 4 ) 6.288 < 0.001 3 ( 3, 3 ) 3 ( 3, 4 ) −3.000 0.003 Standing balance 3 ( 3, 3 ) 4 ( 3, 4 ) 8.012 < 0.001 3 ( 3, 3 ) 3 ( 3, 4 ) −3.317 0.001 Note: The data of CPAx Score and MRC-SS are non-normally distributed, and were expressed by median and quartile. MRC-SS scores in sepsis patients increased from 56 ((IQR 54, 56) to 56 ((IQR 56, 58), while non-sepsis patients showed an improvement from 56 (IQR 56, 56) to 58 (IQR 56, 58). Muscle strength scores were slightly higher in the non-sepsis group (z = -2.198, P < 0.05), as illustrated in Fig. 1 . 3.3 Clinical characteristics of ICU-AW patients As shown in Table 3 , patients diagnosed with ICU-AW ranged in age from 46 to 82 years and presented with complex medical conditions, including high-risk malignancies (e.g., multiple myeloma, gastric cancer, esophageal cancer, recurrent liposarcoma, and biliary masses) complicated by sepsis, multi-organ dysfunction, type 2 diabetes, hypertension, and coronary artery disease. During ICU management, these patients received comprehensive interventions: mechanical ventilation, broad-spectrum antibiotics (e.g., piperacillin-tazobactam, imipenem), corticosteroids (e.g., hydrocortisone, methylprednisolone), analgesic and sedative medications, vasoactive agents for hemodynamic support, and enteral/parenteral nutritional support, alongside ICU rehabilitation. Despite stable vital signs, patients exhibited multiple high-risk factors for ICU-AW, susch as advanced age, severe systemic infections, multi-organ dysfunction syndromes, extended immobility and Chronic malnutrition. Following short-term rehabilitation, no clinically significant improvements in muscle strength (assessed via MRC-SS) or motor Ability (measured by CPAx) were observed, underscoring the challenges of rehabilitating critically ill patients with overlapping risk profiles. Table 3 ICU-AW Cases NO. Gender Age (year) Tumor type Underlying diseases Mal- nutrition Infection site Septic shock Patient 1 M 64 Multiple myeloma Liver and renal insufficiency Yes Pulmonary infection Yes Patient 2 M 71 Gastric cancer Hypertension, Coronary heart disease, Pulmonary emphysema Yes Pulmonary infection, Intra-abdominal infection No Patient3 M 56 Cholangiocarcinoma Type 2 diabetes mellitus Yes Biliary tract infection, Pulmonary infection, Intra-abdominal infection Yes Patient 4 M 46 Colon cancer Abnormal liver function Yes Pulmonary infection, Intra-abdominal infection Yes Patient 5 M 82 Liposarcoma recurrence Type 2 diabetes mellitus Yes Intra-abdominal infection Yes 4 Discussion The gradual increase and persistent prevalence of ICU-AW significantly impair patients’ quality of life and long-term prognosis, imposing a substantial burden on families and society. Previous research has identified several risk factors for ICU-AW, including advanced patient age, severity of illness, prolonged mechanical ventilation, and extended ICU stays. Moreover, modifiable factors such as the use of medications (corticosteroids, sedatives, neuromuscular blockers, vasoactive agents), hyperglycemia, nutritional status, and muscle wasting also play crucial roles in its development[ 15 , 16 ]. A total of 171 critically ill cancer patients were included in this study, with sepsis accounting for 75.44% (129/171). Laboratory indicators such as La, WBC, IL-6, PCT, and CRP, as well as SOFA and APACHE II scores, were significantly elevated in the sepsis group compared to non-sepsis patients; Sepsis patients experience sustained inflammatory responses and cytokine storms, which can contribute to metabolic and endocrine abnormalities. Damage occurs at multiple levels, from cellular effects such as increased apoptosis, necrosis, and impaired mitochondrial respiration, to systemic consequences including enhanced muscle protein breakdown and neuromuscular dysfunction[ 17 ]; Given these multifactorial influences, cancer patients with sepsis are at high risk for ICU-AW[ 18 ]. According to multiple studies, the prevalence of ICU-AW is approximately 40% (95% CI 38–42%) [ 19 – 21 ], with rates rising as high as 67% in patients with sepsis[ 21 ]. Notably, the incidence of ICU-AW in this study was 2.92% (5/171), which is significantly lower than commonly reported. This can be primarily attributed to several factors. First, our study primarily involved postoperative patients with secondary infections, suggesting a relatively shorter duration of critical illness and bed rest prior to rehabilitation. Second, early identification and proactive management of ICU-AW risk factors, such as providing adequate nutritional support to reduce muscle breakdown. Additionally, preventive rehabilitation training was initiated promptly, within 48 hours of mechanical ventilation. Finally, a robust multidisciplinary team approach, involving physicians, nurses, and rehabilitation therapists, facilitated comprehensive care. In sepsis patients, CPAx scores improved from a median of 35 (IQR 33, 37) at baseline to 40 (IQR 38, 42) post-rehabilitation. These findings suggest that early rehabilitation training, encompassing passive and active movements alongside respiratory exercises, positively impacts the restoration of motor function and can effectively reduce the incidence of ICU-AW in sepsis patients, highlighting its significant clinical value. Furthermore, the recovery of functional abilities can notably enhance patients' subjective experience of improvement and bolster their psychological confidence[ 22 ]. MRC-SS for sepsis patients improved from a median of 56 (IQR 54, 56) to 56 (IQR 56, 58), while non-sepsis patients saw an improvement from 56 (IQR 56, 56) to 58 (IQR 56, 58). The overall muscle strength level remained slightly higher in non-sepsis patients compared to sepsis patients (z =−2.198, P < 0.05). These data indicated that short-term rehabilitation yields limited improvement in muscle strength, particularly for sepsis patients, underscoring the necessity of continuous rehabilitation and sustained nutritional support for achieving significant long-term gains. The complex conditions and fragile physiological status of ICU patients present significant challenges to the implementation of early exercise rehabilitation. Optimizing rehabilitation protocols without increasing the risk of adverse events remains an urgent issue to be addressed. Therefore, we should focus on the early identification of risk factors for ICU-AW and deliver personalized rehabilitation interventions tailored to each patient’s specific condition. The results of our study demonstrate that early rehabilitation training can significantly enhance comprehensive motor activity in sepsis patients, underscoring its important clinical value. However, this study also has some limitations. The relatively small sample size and single-center design may introduce bias, potentially affecting the accuracy of the findings. Additionally, the patients’ ICU stays were relatively short, limiting the ability to conduct long-term dynamic monitoring of muscle strength and motor activity. Therefore, future multicenter cohort studies with larger sample sizes and extended follow-up are needed to further evaluate the clinical significance of early rehabilitation in preventing ICU-AW. Declarations Acknowledgements : We appreciate the support of the contributions of all participants. Funding : This study was funded by Noncommunicable Chronic Diseases-National Science and Technology Major Project (Grant number 2024ZD0526000) . Conflicts of interest : All authors declare that there are no conflicts of interest. Ethics approval and consent to participate : This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The ethical approval was given by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital with the following reference numbers:bc20251076. Author contributions : Chen Gao (First Author): Methodology, Formal Analysis, Data Curation, Visualization, Writing-Original Draft; Zhen Zhang: Resources, Writing - Review & Editing; Yang Lyu (Corresponding Author)：Conceptualization,Funding Acquisition, Validation, Supervision, Writing - Review & Editing Consent to participate : All patients consented to participate. Consent to publish : All patients consented to publish. References Gudiol, C., A. Albasanz-Puig, G. Cuervo, J. Carratala (2021) Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance. Front Med (Lausanne) 8: 636547. https://doi.org/10.3389/fmed.2021.636547 . Nates, J.L., F. Pene, M. Darmon, et al. (2024) Septic shock in the immunocompromised cancer patient: a narrative review. Crit Care 28(1): 285. https://doi.org/10.1186/s13054-024-05073-0 . Fuentes-Aspe, R., R. Gutierrez-Arias, F. Gonzalez-Seguel, et al. (2024) Which factors are associated with acquired weakness in the ICU? An overview of systematic reviews and meta-analyses. J Intensive Care 12(1): 33. https://doi.org/10.1186/s40560-024-00744-0 . Liu, J., Z. Xu, S. Luo, Y. Bai, J. Feng, F. Li (2024) Risk factors for ICU-acquired weakness in sepsis patients: A retrospective study of 264 patients. Heliyon 10(11): e32253 .https://doi.org/10.1016/j.heliyon.2024.e32253 . Schefold, J.C., J. Bierbrauer, S. Weber-Carstens (2010) Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. J Cachexia Sarcopenia Muscle 1(2): 147–157. https://doi.org/10.1007/s13539-010-0010-6 . van Wagenberg, L., E. Witteveen, L. Wieske, J. Horn (2020) Causes of Mortality in ICU-Acquired Weakness. J Intensive Care Med 35(3): 293–296. https://doi.org/10.1177/0885066617745818 . Turan, Z., M. Topaloglu, O. Ozyemisci Taskiran (2020) Medical Research Council-sumscore: a tool for evaluating muscle weakness in patients with post-intensive care syndrome. 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(2013) The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy 99(1): 33–41. https://doi.org/10.1016/j.physio.2012.01.003 . Lang, J.K., M.S. Paykel, K.J. Haines, C.L. Hodgson (2020) Clinical Practice Guidelines for Early Mobilization in the ICU: A Systematic Review. Crit Care Med 48(11): e1121-e1128 .https://doi.org/10.1097/CCM.0000000000004574 . Devlin, J.W., Y. Skrobik, C. Gelinas, et al. (2018) Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 46(9): e825-e873 .https://doi.org/10.1097/CCM.0000000000003299 . Rhodes, A., L.E. Evans, W. Alhazzani, et al. (2017) Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 43(3): 304–377. https://doi.org/10.1007/s00134-017-4683-6 . Chen, J., M. Huang (2024) Intensive care unit-acquired weakness: Recent insights. J Intensive Med 4(1): 73–80. https://doi.org/10.1016/j.jointm.2023.07.002 . Yang, Z., X. Wang, F. Wang, Z. Peng, Y. Fan (2022) A systematic review and meta-analysis of risk factors for intensive care unit acquired weakness. Medicine (Baltimore) 101(43): e31405 .https://doi.org/10.1097/MD.0000000000031405 . Williams, J.C., M.L. Ford, C.M. Coopersmith (2023) Cancer and sepsis. Clin Sci (Lond) 137(11): 881–893. https://doi.org/10.1042/CS20220713 . Wang, L., D.Y. Long (2024) Significant risk factors for intensive care unit-acquired weakness: A processing strategy based on repeated machine learning. World J Clin Cases 12(7): 1235–1242. https://doi.org/10.12998/wjcc.v12.i7.1235 . Appleton, R.T., J. Kinsella, T. Quasim (2015) The incidence of intensive care unit-acquired weakness syndromes: A systematic review. J Intensive Care Soc 16(2): 126–136. https://doi.org/10.1177/1751143714563016 . Blot, S., E. Ruppe, S. Harbarth, et al. (2022) Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs 70: 103227. https://doi.org/10.1016/j.iccn.2022.103227 . Li, Z., Q. Zhang, P. Zhang, et al. (2020) Prevalence and risk factors for intensive care unit acquired weakness: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 99(36): e22013 .https://doi.org/10.1097/MD.0000000000022013 . O'Neill, B., N. Green, B. Blackwood, et al. (2024) Recovery following discharge from intensive care: What do patients think is helpful and what services are missing? PLoS One 19(3): e0297012 .https://doi.org/10.1371/journal.pone.0297012 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7025660","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500180206,"identity":"59a1c81a-afd5-451e-93a2-8809d83d975d","order_by":0,"name":"Chen Gao","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Gao","suffix":""},{"id":500180207,"identity":"0941a4a0-8b36-4584-9a0e-5493eea15166","order_by":1,"name":"Zhen Zhang","email":"","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Zhang","suffix":""},{"id":500180208,"identity":"21cfd5f5-9304-42ec-9b6b-65edc72cef81","order_by":2,"name":"Yang Lyu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYBACPigtx8BwgIGBsYEILWxQ2piHZC2JPSCSOC0SOWYSP3fUpu9nPJ0GZDDI84sdIKxFsvfM8dwehrPbgAwGw5mzE4iwhbftGFiLNGMbQ4LBbSK0SP5tO5bOQ5IWad62mgQStPA8K7aWbTtg2HPg7GbL3jYJwn7hZ0/eePNtW508+4yzG2/8bLOR55cmoIVBIIFFgoHhMAODxAEQV4KAcrA1B5g/MDDUARkNRKgeBaNgFIyCEQkAUStBzX8zKV4AAAAASUVORK5CYII=","orcid":"","institution":"Tianjin Medical University Cancer Institute \u0026 Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Lyu","suffix":""}],"badges":[],"createdAt":"2025-07-02 06:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7025660/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7025660/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89386261,"identity":"31693434-2d87-4f57-8676-ae6b790ddbe8","added_by":"auto","created_at":"2025-08-19 12:35:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55433,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the trends in muscle function and activity capacity before and after rehabilitation treatment between the sepsis and non-sepsis patients. a) the changes in CPAx scores; b) the changes in MRC-S scores. Due to the non-normal distribution of the data, paired comparisons were performed using the Wilcoxon signed-rank test. In the boxplots, the boxes represent the median and interquartile range of the scores, while the whiskers indicate the 2.5th to 97.5th percentile range, reflecting the overall distribution of the data.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7025660/v1/4644b58af477af83cf7b94f0.png"},{"id":92821510,"identity":"ff06be05-c728-4a9a-b775-18a6f4d74659","added_by":"auto","created_at":"2025-10-06 02:16:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":853636,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7025660/v1/e6a4e948-5d50-4e62-a48a-52f0a9391ede.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of rehabilitation practices between sepsis and non sepsis patients during Intensive care hospitalization in cancer patients: a retrospective cohort study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eThe global burden of cancer incidence was rapidly growing, and cancer patients were more likely to be immunocompromised due to malignancy itself, recent surgical interventions, or chemotherapy, making them more vulnerable to severe infections[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e], with sepsis being the most common reason for intensive care unit (ICU) admission. Given the high risk of complications and poor outcomes in patients with sepsis, which is an independent risk factor for ICU-acquired weakness (ICU-AW)[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e], it is important to explore whether early physical rehabilitation can support better long-term outcomes without exacerbating risks.\u003c/p\u003e\n\u003cp\u003eICU-AW is definded as an acute neuromuscular injury caused by critical illness, clinically characterized by limb and respiratory muscle weakness in clinical manifestation. It is a severe complication that can lead to prolonged mechanical ventilation, longer hospital stays, reduced quality of life after discharge, and substantially educed long-term survival rates for patients[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, there is still insufficient understanding of ICU-AW in current clinical practice. Due to the lack of clear clinical features in the early stages of the disease, the implementation of rehabilitation intervention strategies were often delayed.\u003c/p\u003e\n\u003cp\u003eThe widely accepted clinical criteria for ICU-AW is manual muscle test, also known as the Medical Research Council score (MRC-SS). When symmetrical delayed weakness occurs (assuming intact cranial nerve function during ICU hospitalization) and the total score of both MRC-SS tests is below 48 points, with an evaluation interval of more than 24 hours, ICU-AW can be diagnosed[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. The limitation is that the MRC-SS scale cannot evaluate the respiratory and motor functions, while the Chelsea Critical Care Physical Assessment Tool (CPAx) covered ten functions of patients from supine to sitting, breathing, coughing, standing, walking, etc., reflecting their comprehensive motor ability and functional independence, and focusing on multidimensional assessment of motor activities [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Early mobility and exercise\u0026rdquo; (i.e. element E) was considered by Lang et al. as key elements in the ICU adult management guidelines published by the Society of Critical Care Medicine (SCCM) in the United State[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, we used the CPAx and MRC-SS scale to evaluate improvements in functional mobility and muscle strength among sepsis patients receiving early rehabilitation, in order to demonstrate the importance of early rehabilitation in preventing ICU-AW.\u003c/p\u003e"},{"header":"2 Object and method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Subjects:\u003c/h2\u003e\u003cp\u003eInclusion criteria: Cancer patients admitted to the ICU who have undergone a joint assessment by both rehabilitation physicians and supervising physicians, and whose condition is deemed relatively stable, are eligible for early rehabilitation training. Exclusion criteria: They have pre-existing limb movement disorders caused by cerebrovascular or orthopedic diseases, that is, limb movement disorders present prior to ICU admission.\u003c/p\u003e\u003cp\u003eAccording to the diagnostic criteria for sepsis in the third international consensus on the definition of sepsis and septic shock (Sepsis-3.0) released by the European Society for Critical Care Medicine in 2016[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; The experimental group consists of patients diagnosed with sepsis, while the control group consists of non sepsis patients.\u003c/p\u003e\u003cp\u003e This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The ethical approval was given by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital with the following reference numbers:bc20251076.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Methods:\u003c/h2\u003e\u003cp\u003eThe patient underwent evaluations using the MRC-SS and CPAx within 48 hours of being transferred to ICU. A reassessment of MRC-SS and CPAx was performed prior to ICU discharge.\u003c/p\u003e\u003cp\u003eRehabilitation training was conducted twice daily, with each session lasting 20 to 30 minutes. The training was categorized into three types based on patient positioning: ① active and passive upper and lower limb exercises performed in a semi-recumbent position on the bed. ② Active upper and lower limb exercises performed in a legged sitting position on the bed. ③Active upper and lower limb exercises performed in a sitting or standing position beside the bed. All training sessions were combined with respiratory exercises, including abdominal breathing, pursed-lip breathing, and assisted coughing and sputum clearance.\u003c/p\u003e\u003cp\u003ePatients demographics and laboratory indicators were collected, including age and gender, SOFA and APACHE II scores, blood routine white blood cell count (WBC); Albumin (ALB); Hemoglobin (Hb); Lactic acid (La); Blood urea nitrogen (BUN), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP); D-dimer (D-D).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Statistical analysis:\u003c/h2\u003e\u003cp\u003eSPSS 19.0 software was used for data processing. After normality testing, normally distributed data are represented by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), while non normally distributed data are expressed as median with interquartile ranges; Categorical variables were compared between groups using the chi-square (χ\u0026sup2;) test. For continuous variables, independent samples t-test was applied to data with normal distribution, whereas the Mann\u0026ndash;Whitney U test was used for non-normally distributed data. Paired sample comparisons between two groups were performed using the Wilcoxon signed-rank test. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Clinical characteristics of sepsis and non sepsis patients\u003c/h2\u003e\u003cp\u003eA total of 171 cancer patients were included in this study, comprising 118 males (69.01%) and 53 females (30.99%), with an average age of 69.29\u0026thinsp;\u0026plusmn;\u0026thinsp;9.88 years. Among them, 129 patients were diagnosed with sepsis, of whom 39.53% (51/129) developed septic shock. The proportion of males was significantly higher in the sepsis group compared to the non-sepsis group (χ\u0026sup2;=0.053, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the sepsis group included 93 males (72.09%) and 36 females (27.91%) with an average age of 69.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.39 years. The non-sepsis group consisted of 25 males (59.52%) and 17 females (32.69%) with an average age of 67.74\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24 years.\u003c/p\u003e\u003cp\u003eLaboratory indicators such as La, WBC, IL-6, PCT, and CRP were significantly elevated in the sepsis group. Correspondingly, SOFA and APACHE II scores indicated more severe illness in the sepsis group. The CPAx score was slightly lower in the sepsis group (z = -3.002, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), whereas no significant difference was observed in MRC-SS between the two groups (z = -1.714, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.087).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Clinical characteristics between ICU Sepsis and Control Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSepsis\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-sepsis\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistical value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, y.o.)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.80 (9.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.74 (11.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSOFA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.86 (2.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.76 (1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPACHEⅡ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.69 (5.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.33 (3.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCPAx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (33, 37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37 (36, 38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;3.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMRC-SS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (54, 56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (56, 56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;1.714\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD-LA (mg/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.3 (1.7, 3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.28 (1.50, 2.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;4.447\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHb (g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107.97 (24.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107.60 (24.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.932\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlbumin (g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.83 (5.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.55 (4.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;1.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBUN (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.8 (7.80, 14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.2 (7.65, 12.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBC (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/ L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.68 (5.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.78 (6.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIL-6 (\u0026micro;g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244.30 (122.15, 399.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.63 (38.60, 124.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;6.804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCT (\u0026micro;g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (0.51, 3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.16 (0.14, 0.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;8.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCRP (mg/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e148.43 (58.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.43 (44.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: The data of CPAx Score, MRC-SS, D-lactic acid, Urea nitrogen, Interleukin-6, and Procalcitonin are all non-normally distributed, which are expressed by median and quartile.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Motor Ability and Muscle Strength in Sepsis Patients Before and After Rehabilitation\u003c/h2\u003e\u003cp\u003eFollowing rehabilitation, CPAx scores in sepsis patients improved significantly from a median of 35 (IQR 33, 37) to 40 (IQR 38, 42). This improvement was observed across all ten assessed items: supine-to-sitting, respiration, coughing, sit-to-stand transition, seated balance, in-bed mobility, bed-to-chair transfer, grip strength, walking, and standing (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Post-treatment CPAx scores were comparable between sepsis and non-sepsis patients, with medians of 40 (IQR 38, 42) and 39.5 (IQR 38, 42), respectively (z = -0.287, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.774).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMRC-SS and CPAx Scores Before and After Rehabilitation Training\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eSepsis(N\u0026thinsp;=\u0026thinsp;129)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eNon-sepsis(N\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBefore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ez\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBefore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAfter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ez\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCPAx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003cp\u003e(33, 37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003cp\u003e(38, 42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;8.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e37\u003c/p\u003e\u003cp\u003e(36, 38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39.5\u003c/p\u003e\u003cp\u003e(38, 42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;5.398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMRC-SS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003cp\u003e(54, 56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003cp\u003e(56, 58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;5.347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e56\u003c/p\u003e\u003cp\u003e(56, 56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58\u003c/p\u003e\u003cp\u003e(56,58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;4.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupine to sitting on the edge of the bed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;7.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(3.75, 4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(4, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;4.690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRespiratory function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;4.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 4, 5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 4, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e(4, 5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;3.873\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSit - to - stand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;5.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDynamic sitting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 4, 5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 5, 5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 4 ,5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 5 ,5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;3.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBed mobility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(4, 5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 5, 5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.786\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e(4.75 ,5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003e( 5 ,5 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;2.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransferring from bed to chair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.736\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;4.243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrip strength\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStepping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;3.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStanding balance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 3 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e( 3, 4 )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;3.317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: The data of CPAx Score and MRC-SS are non-normally distributed, and were expressed by median and quartile.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMRC-SS scores in sepsis patients increased from 56 ((IQR 54, 56) to 56 ((IQR 56, 58), while non-sepsis patients showed an improvement from 56 (IQR 56, 56) to 58 (IQR 56, 58). Muscle strength scores were slightly higher in the non-sepsis group (z = -2.198, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Clinical characteristics of ICU-AW patients\u003c/h2\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, patients diagnosed with ICU-AW ranged in age from 46 to 82 years and presented with complex medical conditions, including high-risk malignancies (e.g., multiple myeloma, gastric cancer, esophageal cancer, recurrent liposarcoma, and biliary masses) complicated by sepsis, multi-organ dysfunction, type 2 diabetes, hypertension, and coronary artery disease.\u003c/p\u003e\u003cp\u003eDuring ICU management, these patients received comprehensive interventions: mechanical ventilation, broad-spectrum antibiotics (e.g., piperacillin-tazobactam, imipenem), corticosteroids (e.g., hydrocortisone, methylprednisolone), analgesic and sedative medications, vasoactive agents for hemodynamic support, and enteral/parenteral nutritional support, alongside ICU rehabilitation.\u003c/p\u003e\u003cp\u003eDespite stable vital signs, patients exhibited multiple high-risk factors for ICU-AW, susch as advanced age, severe systemic infections, multi-organ dysfunction syndromes, extended immobility and Chronic malnutrition. Following short-term rehabilitation, no clinically significant improvements in muscle strength (assessed via MRC-SS) or motor Ability (measured by CPAx) were observed, underscoring the challenges of rehabilitating critically ill patients with overlapping risk profiles.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eICU-AW Cases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNO.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003cp\u003e(year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTumor type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUnderlying diseases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMal-\u003c/p\u003e\u003cp\u003enutrition\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eInfection site\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSeptic shock\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultiple myeloma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLiver and renal insufficiency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePulmonary infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGastric cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHypertension,\u003c/p\u003e\u003cp\u003eCoronary heart disease,\u003c/p\u003e\u003cp\u003ePulmonary emphysema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePulmonary infection, Intra-abdominal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCholangiocarcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eType 2 diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBiliary tract infection, Pulmonary infection, Intra-abdominal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eColon cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAbnormal liver function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePulmonary infection, Intra-abdominal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLiposarcoma recurrence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eType 2 diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eIntra-abdominal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThe gradual increase and persistent prevalence of ICU-AW significantly impair patients\u0026rsquo; quality of life and long-term prognosis, imposing a substantial burden on families and society. Previous research has identified several risk factors for ICU-AW, including advanced patient age, severity of illness, prolonged mechanical ventilation, and extended ICU stays. Moreover, modifiable factors such as the use of medications (corticosteroids, sedatives, neuromuscular blockers, vasoactive agents), hyperglycemia, nutritional status, and muscle wasting also play crucial roles in its development[\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. A total of 171 critically ill cancer patients were included in this study, with sepsis accounting for 75.44% (129/171). Laboratory indicators such as La, WBC, IL-6, PCT, and CRP, as well as SOFA and APACHE II scores, were significantly elevated in the sepsis group compared to non-sepsis patients; Sepsis patients experience sustained inflammatory responses and cytokine storms, which can contribute to metabolic and endocrine abnormalities. Damage occurs at multiple levels, from cellular effects such as increased apoptosis, necrosis, and impaired mitochondrial respiration, to systemic consequences including enhanced muscle protein breakdown and neuromuscular dysfunction[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]; Given these multifactorial influences, cancer patients with sepsis are at high risk for ICU-AW[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAccording to multiple studies, the prevalence of ICU-AW is approximately 40% (95% CI 38\u0026ndash;42%) [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], with rates rising as high as 67% in patients with sepsis[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Notably, the incidence of ICU-AW in this study was 2.92% (5/171), which is significantly lower than commonly reported. This can be primarily attributed to several factors. First, our study primarily involved postoperative patients with secondary infections, suggesting a relatively shorter duration of critical illness and bed rest prior to rehabilitation. Second, early identification and proactive management of ICU-AW risk factors, such as providing adequate nutritional support to reduce muscle breakdown. Additionally, preventive rehabilitation training was initiated promptly, within 48 hours of mechanical ventilation. Finally, a robust multidisciplinary team approach, involving physicians, nurses, and rehabilitation therapists, facilitated comprehensive care.\u003c/p\u003e\n\u003cp\u003eIn sepsis patients, CPAx scores improved from a median of 35 (IQR 33, 37) at baseline to 40 (IQR 38, 42) post-rehabilitation. These findings suggest that early rehabilitation training, encompassing passive and active movements alongside respiratory exercises, positively impacts the restoration of motor function and can effectively reduce the incidence of ICU-AW in sepsis patients, highlighting its significant clinical value. Furthermore, the recovery of functional abilities can notably enhance patients\u0026apos; subjective experience of improvement and bolster their psychological confidence[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eMRC-SS for sepsis patients improved from a median of 56 (IQR 54, 56) to 56 (IQR 56, 58), while non-sepsis patients saw an improvement from 56 (IQR 56, 56) to 58 (IQR 56, 58). The overall muscle strength level remained slightly higher in non-sepsis patients compared to sepsis patients (z =\u0026minus;2.198, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These data indicated that short-term rehabilitation yields limited improvement in muscle strength, particularly for sepsis patients, underscoring the necessity of continuous rehabilitation and sustained nutritional support for achieving significant long-term gains.\u003c/p\u003e\n\u003cp\u003eThe complex conditions and fragile physiological status of ICU patients present significant challenges to the implementation of early exercise rehabilitation. Optimizing rehabilitation protocols without increasing the risk of adverse events remains an urgent issue to be addressed. Therefore, we should focus on the early identification of risk factors for ICU-AW and deliver personalized rehabilitation interventions tailored to each patient\u0026rsquo;s specific condition. The results of our study demonstrate that early rehabilitation training can significantly enhance comprehensive motor activity in sepsis patients, underscoring its important clinical value.\u003c/p\u003e\n\u003cp\u003eHowever, this study also has some limitations. The relatively small sample size and single-center design may introduce bias, potentially affecting the accuracy of the findings. Additionally, the patients\u0026rsquo; ICU stays were relatively short, limiting the ability to conduct long-term dynamic monitoring of muscle strength and motor activity. Therefore, future multicenter cohort studies with larger sample sizes and extended follow-up are needed to further evaluate the clinical significance of early rehabilitation in preventing ICU-AW.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eWe appreciate the support of the contributions of all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;This study was funded by Noncommunicable Chronic Diseases-National Science and Technology Major Project (Grant number 2024ZD0526000) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e:\u0026nbsp;All authors declare that there are no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e:\u0026nbsp;This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The ethical approval was given by the Ethics Committee of Tianjin Medical University Cancer Institute and Hospital with the following reference numbers:bc20251076.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e:\u0026nbsp;Chen Gao (First Author): Methodology, Formal Analysis, Data Curation, Visualization, Writing-Original Draft; Zhen Zhang: Resources, Writing - Review \u0026amp; Editing; Yang Lyu (Corresponding Author)：Conceptualization,Funding Acquisition, Validation, Supervision, Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: All patients consented to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e: All patients consented to publish.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGudiol, C., A. Albasanz-Puig, G. Cuervo, J. 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PLoS One 19(3): e0297012\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.https://doi.org/10.1371/journal.pone.0297012\u003c/span\u003e\u003cspan address=\".10.1371/journal.pone.0297012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cancer, Sepsis, ICU-acquired weakness, Rehabilitation, Critical care practice","lastPublishedDoi":"10.21203/rs.3.rs-7025660/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7025660/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eLong-term outcomes of cancer patients with sepsis have garnered increasing attention, especially in severe rehabilitation. This study aims to explore the improvements in comprehensive motor ability and muscle strength through early rehabilitation treatment in cancer patients with sepsis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eA total of 171 cancer patients were included in this retrospective study. Muscle strength and motor ability were assessed using Medical Research Council score (MRC-SS) and Chelsea Critical Care Physical Assessment Tool (CPAx)；Wilcoxon signed-rank and Mann-Whitney U tests were used to assess improvements after rehabilitation as well as the differences between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1. Patients in the sepsis group exhibited slightly lower CPAx scores compared to the non sepsis group (z=-3.002, \u003cem\u003eP\u003c/em\u003e=0.003). After early rehabilitation treatment, the CPAx scores were improved from 35 (IQR 33, 37) to 40 (IQR 38, 42), with significant differences observed in statistical analysis (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05); The MRC-SS scores were improved from 56 (IQR54, 56) to 56 (IQR56, 58), but the overall muscle strength score was slightly lower than that of non sepsis patients (z=-2.198, \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e2. Five patients were diagnosed with ICU-acquired weakness (ICU-AW), all of whom were sepsis patients multiple risk factors. Early rehabilitation did not yield significant improvements in muscle strength or motor ability in this subgroup.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eEarly rehabilitation is essential for patients with sepsis to enhance motor activity and provide them a tangible sense of recovery. At the same time, the challenges of rehabilitation for critically ill patients with overlapping risks were also emphasized.\u003c/p\u003e","manuscriptTitle":"Comparison of rehabilitation practices between sepsis and non sepsis patients during Intensive care hospitalization in cancer patients: a retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:35:14","doi":"10.21203/rs.3.rs-7025660/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6a82cc7-a61a-46d5-b1a7-78708c4d91f7","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T02:08:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:35:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7025660","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7025660","identity":"rs-7025660","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}