Reduced Handgrip Strength in Hospital Admission Predicts Prolonged Hospital Stay and Death but Is Not Accurate to Identify Malnutrition: A Longitudinal Study of Reduced Handgrip Strength in Hospitalized Patients

Abstract

Background Malnourished patients present impairment of functionality due to loss of strength and muscle mass. However, the validity of handgrip strength (HGS) in identifying malnutrition and its association with clinical outcomes in hospitalized patients requires investigation. Aims Evaluate the accuracy of HGS in identifying malnutrition, its association with clinical outcomes, and the change in HGS in the first 2 weeks of hospitalization. Methods A prospective cohort study with adult/elderly patients. Subjective Global Assessment (SGA) was applied in the first 48 hours for malnutrition diagnosis, and HGS was measured in this moment and after 7 and 14 days of hospital admission. HGS <20 kg for females and <30 kg for males was considered reduced. Outcomes of interest were prolonged hospital stay (LOS) and in‐hospital death. Results Six hundred patients (55.75 ± 14.78 years, 51.5% males) were included, 34.0% of them were malnourished (SGA‐B or SGA‐C), and 37.2% presented reduced HGS. The concordance between reduced HGS and SGA in malnutrition diagnosis was weak (κ = 0.192), and accuracy was not satisfactory (area under the receiver operating characteristic curve = 0.599 [95% CI, 0.551–0.648]). HGS did not change during the hospitalization. Reduced HGS increased by 1.2 times (95% CI, 1.03–1.40) the odds for prolonged LOS and 9.11 times (95% CI, 1.13–73.60) the risk of death. Conclusion Reduced HGS did not present satisfactory accuracy to identify malnutrition, and HGS did not change during the first 14 days of hospitalization, but was associated with prolonged LOS and in‐hospital death.

Handgrip strength is associated with length of stay and functional outcomes at 1-year follow up in fragility hip fracture patients

“…Our findings were similar to previous study that HGS could predict prolonged hospital stay in hospitalized patients. 10 Although reduced HGS did not provide satisfactory accuracy to identify malnutrition, HGS is a potential assessment to enhance nutrition assessment. 10,18 However, clinicians or therapists should take note that malnutrition is associated with increased morbidity and clinical complications, higher risk of infections and mortality.…”

“…However, few studies have shown that pre-operative HGS was associated with patients’ LOS. 10,11 In the meantime, limited studies have investigated the relationship between HGS and long-term validated functional outcomes. 12–14…”

Body composition and risk factors associated with sarcopenia in post-COVID patients after moderate or severe COVID-19 infections

“…In our population, 47.36% had low muscle strength. This was an independent predictor of poor patient outcomes such as persistent fatigue, diminished capacity to perform activities of daily living, pulmonary function, physical functioning, prolonged hospital stay, poor health-related quality of life, and mortality in other populations [ 11 , 12 , 15 , 16 , 30 – 32 ]. Cheval et al also showed that muscle strength was an independent risk factor for COVID-19 hospitalization (OR: 0.64, 95% CI: 0.45–0.92, p = 0.015) [ 33 ].…”

Prognostic Value of Isolated Sarcopenia or Malnutrition–Sarcopenia Syndrome for Clinical Outcomes in Hospitalized Patients

“…In a large cohort study involving geriatric inpatients ( n = 1406), sarcopenia was associated with 3-month and 1-year mortality in males (HR 3.72; 95% CI 2.06–6.72; HR 1.92; 95% CI 1.34–2.77) and females (HR 2.95; 95% CI 1.56–5.60; HR 2.93; 95% CI 1.89–4.54) [ 35 ]. Studies involving patients with different types of cancer, pooled in a systematic review with meta-analysis, showed an overall HR on cancer mortality of 1.69 (95% CI 1.56–1.83) for patients with sarcopenia [ 36 ]. In a bi-centered prospective cohort study conducted with older individuals, MSS, sarcopenia, sarcopenia with malnutrition risk, and malnutrition groups were independently associated with all-cause mortality at two years.…”