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
Victória Silva Chites, Paula Portal Teixeira, Júlia Lima, Camila Ferri Burgel, Thainá Gattermann Pereira, Flávia Moraes Silva
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.