Abstract
Objectives
To assess the relationship between muscular strength measures and mortality in outpatient
populations with chronic diseases such as cancer, chronic obstructive pulmonary disease,
renal disease, and metabolic and vascular diseases, and in critically ill hospitalized
patients.
Design
A systematic review and random-effects meta-analysis of prospective cohort studies
was performed.
Setting and participants
The databases Medline, Embase, Clinical Trial Register, and Cochrane Trial Register
were searched from inception until September 30, 2018. The systematic literature review
yielded 39 studies with a total of 39,852 participants.
Results
Lowest vs highest category of muscular strength revealed a statistically significant
increased risk of all-cause mortality with a hazard ratio (HR) and 95% confidence
intervals (CI) of 1.80 (95% CI 1.54–2.10). Lower muscular strength was associated
with enhanced mortality in patients with cancer (HR 2.40; 95% CI 1.57–3.69), critical
illness (HR 2.06; 95% CI 1.33–3.21), renal disease (HR 1.84; 95% CI 1.37–2.47), metabolic
and vascular diseases (HR 1.64; 95% CI 1.26–2.14), and chronic obstructive pulmonary
disease (HR 1.36; 95% CI 1.16–1.61). Conversely, a 5-kg higher level of muscular strength
conferred a reduced risk of overall mortality (HR 0.72; 95% CI 0.59–0.89) and was
accompanied by a reduction in mortality in patients with metabolic and vascular diseases
(HR 0.52; 95% CI 0.29–0.91), critical illness (HR 0.78; 95% CI 0.61–0.99), and renal
disease (HR 0.82; 95% CI 0.73–0.91).
Conclusions and implications
Muscular strength is inversely associated with mortality risk in various acute and
chronic conditions. Future trials should focus on developing validated cut-points
for diagnosing low muscular strength and their predictive value for hard end-points.
Keywords
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Article info
Publication history
Published online: July 19, 2019
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
