Background

Grip strength is one of the main components for the physical functioning in sarcopenia and physical frailty.

Objectives

To explore the role of grip strength measurement at admission for predicting disease severity in COVID-19.

Methods

Demographic data, smoking status, comorbidities, COVID-19 related symptoms, grip strength, laboratory and computed tomography (CT) findings at admission were all noted. Using a Smedley hand dynamometer, the maximum grip strength value (kg) after three measurements on the dominant side was recorded. Low grip strength was defined as two standard deviations below the gender-specific peak mean value of the healthy young adults (<32 kg for males, <19 kg for females). Patients were categorized into three groups according to clinical and CT findings. Severe illness group had pneumonia with a respiratory rate >30/min, oxygen saturation ≤90%, or extensive lung involvement in CT. Moderate illness group had pneumonia with CT score ≤11. Mild illness group had normal CT findings.

Results

The study population included 312 patients (140 F, 172 M). The distribution of mild, moderate and severe disease groups were 36.9%, 51.0% and 12.2%, respectively. Cough, fever, dyspnea, hypertension, obesity, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) were most frequent, and C-reactive protein (CRP), ferritin, D-dimer, and neutrophil levels were highest in the severe group (all p<.05). Absolute grip strength values were lowest and the frequency of having low grip strength were highest in the severe group (both p<.01). Since we found that the significant differences were stemming from the severe group, we combined the mild and moderate group as non-severe, and compared severe vs. non-severe groups with binary logistic regression analyses. When age, gender, body mass index, smoking status, presence of comorbidities and low grip strength, and abnormal laboratory findings were taken into analyses; age (odds ratio [OR]: 1.054 [95% confidence interval (CI): 1.020-1.089]), obesity (OR: 2.822 [95% CI: 1.143-6.966]), COPD (OR: 5.699 [95 %CI: 1.231-26.383]), CRP level (OR: 1.023 [95% CI: 1.010-1.036]) and low grip strength (OR: 3.047 [95% CI: 1.146-8.103]) were observed to be independent predictors for severe COVID-19 disease (all p<.05).

Conclusions

In addition to the well-known independent risk factors (i.e. age, obesity, COPD, and CRP level), low grip strength independently increased (about three times) the severity of COVID-19.

中文翻译：

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握力作为住院 COVID-19 患者疾病严重程度的预测指标

背景

握力是肌肉减少症和身体虚弱的身体机能的主要组成部分之一。

目标

探讨入院时握力测量在预测 COVID-19 疾病严重程度中的作用。

方法

入院时的人口统计数据、吸烟状况、合并症、COVID-19 相关症状、握力、实验室和计算机断层扫描 (CT) 检查结果均已记录。使用 Smedley 手测力计，记录优势侧三次测量后的最大握力值 (kg)。低握力被定义为低于健康年轻人的性别特异性峰值平均值的两个标准差（男性<32 公斤，女性<19 公斤）。根据临床和 CT 结果将患者分为三组。重症组肺炎呼吸频率>30次/分，血氧饱和度≤90%，或CT显示肺广泛受累。中度组有肺炎CT评分≤11分。轻症组CT表现正常。

结果

研究人群包括 312 名患者（140 F，172 M）。轻度、中度和重度疾病组的分布分别为36.9%、51.0%和12.2%。咳嗽、发热、呼吸困难、高血压、肥胖、心血管疾病（CVD）和慢性阻塞性肺疾病（COPD）最常见，重症患者C反应蛋白（CRP）、铁蛋白、D-二聚体和中性粒细胞水平最高组（所有 p <.05）。严重组的绝对握力值最低，握力低的频率最高（均 p <.01）。由于我们发现重度组存在显着差异，因此我们将轻度和中度组合并为非重度组，并使用二元逻辑回归分析比较重度组与非重度组。当年龄、性别、体重指数、吸烟状况、合并症和低握力的存在，以及异常的实验室检查结果被纳入分析；年龄（比值比 [OR]：1.054 [95% 置信区间 (CI)：1.020-1.089]），肥胖（OR：2.822 [95% CI：1.143-6.966]），COPD（OR：5.699 [95%CI： 1.231-26.383]）、CRP 水平（OR：1.023 [95% CI：1.010-1.036]）和低握力（OR：3.047 [95% CI：1.146-8.103]）被观察为严重 COVID- 19 种疾病（所有 p<.05）。

结论

除了众所周知的独立危险因素（即年龄、肥胖、慢性阻塞性肺病和 CRP 水平）外，低握力独立增加了（约三倍）COVID-19 的严重程度。