OBJECTIVES: To examine the association between muscle strength and total and cause‐specific mortality and the plausible contributing factors to this association, such as presence of diseases commonly ...underlying mortality, inflammation, nutritional deficiency, physical inactivity, smoking, and depression.
DESIGN: Prospective population‐based cohort study with mortality surveillance over 5 years.
SETTING: Elderly women residing in the eastern half of Baltimore, Maryland, and part of Baltimore County.
PARTICIPANTS: Nine hundred nineteen moderately to severely disabled women aged 65 to 101 who participated in handgrip strength testing at baseline as part of the Women's Health and Aging Study.
MEASUREMENTS: Cardiovascular disease (CVD), cancer, respiratory disease, other measures (not CVD, respiratory, or cancer), total mortality, handgrip strength, and interleukin‐6.
RESULTS: Over the 5‐year follow‐up, 336 deaths occurred: 149 due to CVD, 59 due to cancer, 38 due to respiratory disease, and 90 due to other diseases. The unadjusted relative risk (RR) of CVD mortality was 3.21 (95% confidence interval (CI) = 2.00–5.14) in the lowest and 1.88 (95% CI = 1.11–3.21) in the middle compared with the highest tertile of handgrip strength. The unadjusted RR of respiratory mortality was 2.38 (95% CI = 1.09–5.20) and other mortality 2.59 (95% CI = 1.59–4.20) in the lowest versus the highest grip‐strength tertile. Cancer mortality was not associated with grip strength. After adjusting for age, race, body height, and weight, the RR of CVD mortality decreased to 2.17 (95% CI = 1.26–3.73) in the lowest and 1.56 (95% CI = 0.89–2.71) in the middle, with the highest grip‐strength tertile as the reference. Further adjustments for multiple diseases, physical inactivity, smoking, interleukin‐6, C‐reactive protein, serum albumin, unintentional weight loss, and depressive symptoms did not materially change the risk estimates. Similar results were observed for all‐cause mortality.
CONCLUSION: In older disabled women, handgrip strength was a powerful predictor of cause‐specific and total mortality. Presence of chronic diseases commonly underlying death or the mechanisms behind decline in muscle strength in chronic disease, such as inflammation, poor nutritional status, disuse, and depression, all of which are independent predictors of mortality, did not explain the association. Handgrip strength, an indicator of overall muscle strength, may predict mortality through mechanisms other than those leading from disease to muscle impairment. Grip strength tests may help identify patients at increased risk of deterioration of health.
Objectives We evaluated the clinical significance and identified the predictors of the universal definition of perioperative bleeding (UDPB) classes in patients undergoing isolated coronary artery ...bypass grafting (CABG). Methods Data on antithrombotic medication, perioperative bleeding, blood transfusion, and adverse events were available for 2764 patients who had undergone isolated CABG. Results The Papworth risk score correlated significantly with the UDPB classes (rate of UDPB class 3-4 and Papworth risk score of 0, 12.1%; 1, 23.9%; 2, 37.5%; and 3, 45.0%; P < .0001). Ordinal regression showed that increased age, female sex, low body mass index, low estimated glomerular filtration rate, low hemoglobin, dialysis, urgent or emergency operation, critical status, on-pump surgery, potent antiplatelet drug pause of <5 days, and warfarin pause of <2 days were independent predictors of high UDPB classes. These risk factors also predicted UDPB classes 3-4 in logistic regression analysis. Increasing UDPB classes were associated with an increased risk of in-hospital mortality ( P = .002), stroke ( P = .023), low cardiac output ( P < .0001), prolonged use of inotropes ( P < .0001), renal replacement therapy ( P < .0001), length of stay in the intensive care unit ( P < .0001), and late mortality ( P < .0001) as assessed by multilevel propensity score-adjusted analysis. Similar findings were observed in the propensity score-adjusted analysis for the most severe grades of perioperative bleeding (ie, UDPB class 3-4). Conclusions High UDPB classes were associated with significantly poorer immediate and late outcomes. The UDPB classification seems to be a valuable research tool to estimate the severity of bleeding and its prognostic impact affect after coronary surgery.
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