Handgrip strength is a substitutive metric to the GLIM criteria–defined malnutrition and predicts long‐term mortality among hospitalized patients with cirrhosis

Abstract

BackgroundHospitalized patients with cirrhosis are prone to debilitating health conditions and fluid fluctuations, posing barriers to accurately obtain anthropometric measures and physical examinations as surrogates for muscle mass within the Global Leadership Initiative on Malnutrition (GLIM). We hypothesize the handgrip strength (HGS) would serve as a substitutive metric, by comparing the diagnostic consistency and prognostic accuracy with computed tomography–demarcated skeletal muscle index (SMI)–defined malnutrition according to the GLIM criteria.MethodsPatients with cirrhosis underwent a two‐step approach involving nutrition risk screening and those fulfilling GLIM consensus were further diagnosed. The evaluation of muscle mass as one constituent contained in the GLIM criteria was conducted by SMI and HGS, respectively. Consistency test, Kaplan‐Meier curve, and multivariate Cox regression were used to assess the performance of GLIM‐SMI and GLIM‐HGS.ResultsAmong 184 hospitalized patients with cirrhosis, 63 (34.2%) and 78 (42.4%) were diagnosed with malnutrition following GLIM‐SMI and GLIM‐HGS criteria, respectively. Considering the GLIM‐SMI a gold standard, GLIM‐HGS had a sensitivity of 87.3% and a specificity of 81.0%. GLIM‐HGS criteria denoted good agreement (κ value = 0.858, P < 0.001) as compared with GLIM‐SMI. Both criteria were independently associated with 1‐year all‐cause mortality, whereas GLIM‐SMI showed slightly higher hazard ratios. Moreover, HGS positively correlated with SMI in the population alongside more pronounced correlation among patients at nutrition risk.ConclusionHGS may serve as a substitutive metric of muscle mass contained in the GLIM criteria to diagnose malnutrition and predict long‐term mortality among patients with cirrhosis.

Significance of malnutrition defined with Global Leadership Initiative on Malnutrition criteria in patients with hepatocellular carcinoma after hepatic resection

“…There are an increasing number of reports that the prediction accuracy of short-and long-term performance is improved by using modified criteria including physical functions such as handgrip strength, [12][13][14] which was also included in this study. Sarcopenia is a syndrome characterized by the progressive and generalized loss of skeletal muscle mass and strength, with a risk of adverse outcomes such as physical disability, poor quality of life, and death.…”

“…The modified GLIM criteria was established using both handgrip strength and skeletal muscle mass, instead of only reduced skeletal muscle mass of the GLIM criteria according to previous reports. [12][13][14] HEPATOLOGY RESEARCH HARIMOTO ET AL. -1237…”

“…Furthermore, in the most recent report, the modified GLIM criteria using handgrip strength also predicted shortand long-term mortality in cancer patients. [12][13][14] However, to the best of our knowledge, no published reports have investigated not only the relationship between GLIM score and HCC patients, but also whether to include skeletal muscle area or handgrip in the definition of GLIM in HCC patients.…”