Prognostic value of physical function tests: hand grip strength and six-minute walking test in elderly hospitalized patients

Esther Martín-Ponce, Iván Hernández-Betancor, Emilio González-Reimers, Rubén Hernández-Luis, Antonio Martínez-Riera, Francisco Santolaria, Esther Martín-Ponce, Iván Hernández-Betancor, Emilio González-Reimers, Rubén Hernández-Luis, Antonio Martínez-Riera, Francisco Santolaria

Abstract

To discern if physical function test are better mortality predictors than muscle mass in elderly hospitalized patients, we analyzed the prognostic value of muscle mass malnutrition and compared it with physical muscle function tests, including the six-minute walking test (6 MWT) and hand grip strength. We included the ankle brachial index (ABI) to assess arterial disease, related to muscle atrophy due to hypoperfusion. We also analyzed the relationship of ABI with malnutrition, physical function tests and survival. We studied 310 hospitalized patients older than 60 years. To assess nutritional status, we determined BMI, triceps skinfold and mid-arm muscle area; we performed a subjective nutritional assessment; and evaluated the degree of inflammatory stress. We assessed physical function by hand grip strength and 6 MWT. We evaluated arterial disease by ABI. Forty-one patients died during hospitalization; 269 were discharged and followed for a mean 808 days, reaching a mortality of 49%. Muscle malnutrition was frequent and was related to mortality, but the best predictors were physical function tests: inability to perform the 6 MWT and low handgrip strength. Function tests were closely related to each other and correlated with nutritional data. Reduced ABI was related to impaired nutritional status, physical function tests and mortality.

References

    1. Martín-Ponce E. et al. Factors involved in the paradox of reverse epidemiology. Clin. Nutr. 29, 501–506 (2010).
    1. Casas-Vara A. et al. The obesity paradox in elderly patients with heart failure: analysis of nutritional status. Nutrition 28, 616–622 (2012).
    1. Vecchiarino P., Bohannon R. W., Ferullo J. & Maljanian R. Short-term outcomes and their predictors for patients hospitalized with community-acquired pneumonia. Heart & Lung. 33, 301–307 (2004).
    1. Norman K., Stobäus N., Gonzalez M. C., Schulzke J. D. & Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 30, 135–42 (2011).
    1. De Buyser S. L. et al. Physical function measurements predict mortality in ambulatory older men. Eur J Clin Invest 43, 379–386 (2013).
    1. Taekema D. G., Gussekloo J., Westendorp R. G., de Craen A. J. & Maier A. B. Predicting survival in oldest old people. Am. J. Med. 125, 1188–1194 (2012).
    1. Studenski S. et al. Gait Speed and Survival in Older Adults. JAMA 305, 50–58 (2011).
    1. Roubenoff R. Sarcopenia: a major modifiable cause of frailty in the elderly. J. Nutr. Health. Aging 4, 140–142 (2000).
    1. Vanitallie T. B. Frailty in the elderly: contributions of sarcopenia and visceral protein depletion. Metabolism 52, 22–26 (2003).
    1. Pasqualini L. et al. Prognostic value of low and high ankle-brachial index in hospitalized medical patients. Eur. J. Intern. Med. 23, 240–244 (2012).
    1. Taylor-Piliae R. E. et al. Ankle brachial index screening in asymptomatic older adults. Am. Heart. J. 161, 979–985 (2011).
    1. Sheng C. S. et al. Four-limb blood pressure as predictors of mortality in elderly Chinese. Hypertension. 61, 1155–1160 (2013).
    1. Charlson M. E., Pompei P., Ales K. L. & MacKenzie C. R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic. Dis. 40, 373–383 (1987).
    1. González-Hermoso F., Porta R. & Herrero A. Resultados del estudio antropométrico de la población canaria adulta. Nutr. Hosp. 5, 238–247 (1990).
    1. Tormo A. et al. Short-term prognostic value of subjective nutritional assessment in general medical patients. J. Nutr. Med. 4, 287–295 (1994).
    1. Kalantar-Zadeh K., Kopple J. D., Humphreys M. H. & Block G. Comparing outcome predictability of markers of malnutrition-inflammation complex syndrome in haemodialysis patients. Nephrol. Dial. Transplant. 19, 1507–1519 (2004).
    1. Chau N. et al. Comparison between estimates of hand volume and hand strengths with sex and age with and without anthropometric data in healthy working people. Eur. J. Epidemiol. 13, 309–316 (1997).
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am. J. Respir. Crit. Care. Med. 166, 111–117 (2002).
    1. Ghannam M., Rodriguez Y., Ehrmann D. & Grossman P. M. Ankle-brachial index as a clinical tool. Am. J. Med. 125, 1171–1172 (2012).
    1. Mutikainen S. et al. Walking ability and all-cause mortality in older women. Int. J. Sports. Med. 32, 216–222 (2011).
    1. De Feo S. et al. The inability to perform a 6 minute walking test after cardio-thoracic surgery is a marker of clinical severity and poor outcome. Data from the ISYDE-2008 Italian survey. Int. J. Cardiol. 151, 115–116 (2011).
    1. Stanaway F. F. et al. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. B.M.J. 343, d7679 (2011).
    1. Suárez-Santamaría M. et al. Prognostic value of inflammatory markers (notably cytokines and procalcitonin), nutritional assessment, and organ function in patients with sepsis. Eur. Cytokine Netw. 21, 19–26 (2010).
    1. Ling C. H. et al. Handgrip strength and mortality in the oldest old population: the Leiden 85-plus study. C.M.A.J. 182, 429–435 (2010).
    1. Rantanen T. et al. Midlife muscle strength and human longevity up to age 100 years: a 44-year prospective study among a decedent cohort. Age (Dordr) 34, 563–570 (2012).
    1. Savino E. et al. Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am. J. Med. 126, 1068–1075 (2013).
    1. Vetrano D. L. et al. Association of Sarcopenia With Short- and Long-term Mortality in Older Adults Admitted to Acute Care Wards: Results From the CRIME Study. J. Gerontol. A. Biol. Sci. Med. Sci. 69, 1154–1161 (2014).
    1. Naqvi A. Z., Davis R. B. & Mukamal K. J. Nutrient intake and peripheral artery disease in adults: Key considerations in cross-sectional studies. Clin. Nutr. 33, 443–447 (2014).
    1. Antonopoulos S. et al. High prevalence of subclinical peripheral artery disease in Greek hospitalized patients. Eur. J. Intern. Med. 16, 187–191 (2005).
    1. Ochi M. et al. Arterial stiffness is associated with low thigh muscle mass in middle-aged to elderly men. Atherosclerosis 212, 327–332 (2010).
    1. Sampaio R. A. et al. Arterial stiffness is associated with low skeletal muscle mass in Japanese community-dwelling older adults. Geriatr. Gerontol. Int. 14 (Suppl. 1), 109–114 (2014).
    1. Vandewoude M. F., Alish C. J., Sauer A. C. & Hegazi R. A. Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? J. Aging Res. 2012, 651570 (2012).
    1. Umanskaya A. et al. Genetically enhancing mitochondrial antioxidant activity improves muscle function in aging. Proc Natl Acad Sci USA 111, 15250–15255 (2014).
    1. Santulli G., Ciccarelli M., Trimarco B. & Iaccarino G. Physical activity ameliorates cardiovascular health in elderly subjects: the functional role of the β adrenergic system. Front Physiol. 209, 1–7 (2013).

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel