School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China.
Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
Eur Geriatr Med. 2023 Apr;14(2):251-262. doi: 10.1007/s41999-023-00768-z. Epub 2023 Mar 23.
This study aimed to determine the association of absolute and relative HGS indicators with postoperative short-term outcomes in older patients with gastric cancer.
The prospective, single-center, observational study involved 230 patients (age ≥ 60 years) who underwent radical gastrectomy. Absolute HGS was directly obtained from results measured by a hand dynamometer, while relative HGS was calculated as the value of absolute HGS divided by body mass index (BMI), appendicular skeletal muscle mass index (ASMI) and age, respectively. Low absolute HGS was defined according to the criterion in AWGS 2019 consensus and the first gender-specific quartile. Low relative handgrip strength was defined if it was below the first gender-specific quartile of the distribution. Postoperative outcomes included total complications, malnutrition and length of hospital stay. Univariate and multivariate regression models were performed to investigate and compare the predictive values of different HGS indicators.
For the five HGS indicators, multivariate analyses showed that low absolute HGS (AWGS consensus), low HGS/BMI and HGS/age were independent risk factors for both postoperative total complications (absolute HGS(AWGS consensus): OR 2.03, 95%CI:1.05-3.93; HGS/BMI: OR 2.12, 95%CI 1.05-4.28; HGS/age: OR 2.79, 95%CI 1.40-5.54) and malnutrition (absolute HGS(AWGS consensus): OR 2.01, 95%CI 1.10-3.67; HGS/BMI: OR 2.28, 95%CI 1.20-4.33; HGS/age: OR 2.70, 95%CI 1.42-5.14). Low absolute HGS (quartile) was an independent risk factor for malnutrition (OR 1.96, 95%CI 1.04-3.71). Moreover, Low HGS/age was associated with lengthened postoperative hospital stay (OR 2.07, 95%CI 1.12-3.85).
Except HGS/ASMI, both absolute and relative HGS indicators were associated with postoperative short-term outcomes. Particularly, HGS/age revealed relatively better predictive value for the studied outcomes.
本研究旨在确定绝对和相对握力指标与老年胃癌患者术后短期结局的关系。
这是一项前瞻性、单中心、观察性研究，纳入了 230 名（年龄≥60 岁）接受根治性胃切除术的患者。绝对握力直接由手持测力计测量结果获得，而相对握力则分别通过绝对握力除以体重指数（BMI）、四肢骨骼肌指数（ASMI）和年龄来计算。根据 2019 年 AWGS 共识和第一性别四分位值标准，将低绝对握力定义为低水平。如果相对握力低于分布的第一性别四分位值，则定义为低相对握力。术后结局包括总并发症、营养不良和住院时间。采用单变量和多变量回归模型来探讨和比较不同握力指标的预测价值。
对于 5 项握力指标，多变量分析显示，低绝对握力（AWGS 共识）、低握力/ BMI 和握力/年龄是术后总并发症（绝对握力（AWGS 共识）：OR 2.03，95%CI：1.05-3.93；握力/ BMI：OR 2.12，95%CI 1.05-4.28；握力/年龄：OR 2.79，95%CI 1.40-5.54）和营养不良（绝对握力（AWGS 共识）：OR 2.01，95%CI 1.10-3.67；握力/ BMI：OR 2.28，95%CI 1.20-4.33；握力/年龄：OR 2.70，95%CI 1.42-5.14）的独立危险因素。低绝对握力（四分位数）是营养不良的独立危险因素（OR 1.96，95%CI 1.04-3.71）。此外，低握力/年龄与术后住院时间延长相关（OR 2.07，95%CI 1.12-3.85）。
除握力/ ASMI 外，绝对和相对握力指标均与术后短期结局相关。特别是，握力/年龄对研究结局具有相对较好的预测价值。
