Anabolic Steroid Use for Weight and Strength Gain in Critically Ill Patients: A Case Series and Review of the Literature

Table 1

Overview of indications and results of anabolic steroid supplementation.

	Indication for anabolic steroids	Date of first dose administered	Testosterone level before administration	Weight change after administration	Grip strength change	Strength change
Patient 1	Profound critical illness weakness	Day 32 of ICU stay	0.6 nmol/L (<2.0 nmol/L)	+7.3 kg; 45 kg (22/4) 52.3 (15/5)	(L) +4.4 kg; (R) +6 kg	From 1/5 power globally to ambulation with minimal assist on discharge
Patient 2	Profound critical illness weakness	Day 82 of ICU stay	5.7 nmol/L (1035 nmol/L)	−3.8 kg; 115.8 kg (3/9) 112 (17/9)	(L) −0.6 kg; (R) +5.7 kg	From profound generalised weakness (0-1/5) to multiple repetitions of assisted sitting to stand exercises and tracheostomy decannulation
Patient 3	Profound critical illness weakness	Day 30 of ICU stay	Not available	+1.5 kg; 72.5 kg (23/5) 74 kg (26/5)	Grip strengths not assessed	From profound weakness (flicker contraction 1/5) to increased strength in all muscle groups (3-4/5)
Patient 4	Long-term malnutrition and inability to gain weight or strength	Day 70 of admission and ICU review for ongoing TPN/nutritional advice	6.5 nmol/L (10–35 nmol/L)	+4.4 kg	(L) −3.6 kg; (R) −3.4 kg	Power globally 3/5.; From fatigue on transfers to ambulating independently for very short distances with frame

Handgrip threshold of 11 kg force in males and 7 kg force in females for the diagnosis of ICU acquired weakness (sensitivity 80.6%, specificity 83.2%, NPV 92.3%, and PPV 63.0%) [13].