Evaluating repeated handgrip strength measurements as predictors of mortality in malnourished hospitalized patients. Secondary analysis of a randomized controlled trial

BACKGROUND: Handgrip strength (HGS) is a simple yet effective bedside tool for assessing muscle strength, which plays an important role in clinical evaluation and monitoring. We hypothesize that repeated measurements of HGS during the hospital stay may serve as a reliable and robust indicator of clinical course and outcomes. METHODS: We re-analyzed data from 565 out of 2028 patients who had repeated handgrip measurement (on admission and on day 7) included in EFFORT, a Swiss-wide multicenter, randomized controlled trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 180-day all-cause mortality. RESULTS: The mean change in HGS from baseline to day 7 was 0.6 kg (SD 4.2) in female and 0.7 kg (SD 3.7) in male patients. Patients with a positive HGS trend had a lower risk of dying within 180 days compared to patients without a positive trend (mortality 11.4% vs. 25.4%, adjusted HR 0.45 [95% CI 0.27 to 0.77], p = 0.003). The change in HGS was also associated with the nutritional intake during the hospitalization in male patients: those who met their energy and protein targets were twice as likely to have an increase in HGS during hospitalization (adjusted OR 2.05 [95% CI 1.23 to 3.42], p = 0.006). CONCLUSIONS: Achieving nutritional targets was associated with a short-term increase in HGS during hospitalization, and a positive HGS trend was associated with a lower risk of mortality after 180 days. These data provide evidence that repeated HGS measurements are a robust bedside tool for assessing and monitoring patients receiving nutritional therapy in the hospital. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02517476