Utility of Hand Grip Strength in Predicting Mortality Risk in Chronic Limb-Threatening Ischemia

Chronic limb-threatening ischemia (CLTI) is associated with increased mortality, reported as high as 50% at 5 years. Sarcopenia, defined as low skeletal muscle strength, quantity, and quality, is associated with adverse outcomes. This study investigated the association of sarcopenia using hand grip strength with 2-year mortality in people with CLTI.

This single-center prospective cohort study (NCT04027244) included patients undergoing procedures for CLTI between May 2019 and May 2021 (minimum age: ≥65 initially; ≥50 from November 2019). Hand grip strength was measured using the Jamar+ digital hand dynamometer with 5 seated repetitions bilaterally. Sarcopenia was defined as maximum grip strength of <16 kg in women and <27 kg in men. The association of sarcopenia with 2-year mortality was analyzed using Cox regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). The multivariable model adjusted for age, sex, frailty and Charlson comorbidity index (CCI).

Ninety-seven participants were included. Twenty-five (26%) had sarcopenia on hand grip strength. Those with sarcopenia were a mean 11.5 years older (P < 0.001). Sarcopenia was also associated with worse Wound, Ischemia, foot Infection clinical stage (P = 0.011), frailty (P = 0.001), and greater CCI score (P = 0.012). At 2-years, 25 people (26%) had died: 17 of whom had sarcopenia (68%) compared to 8 without (32%). Sarcopenia was independently associated with worse 2-year mortality (HR 6.4; 95% CI 2.4, 17.2; P < 0.001).

Hand grip strength was strongly associated with worse 2-year survival in people with CLTI. Grip strength may be a useful adjunct to risk stratification and aid shared decision-making in CLTI.