Use of handgrip dynamometry for diagnosis and prognosis assessment of intensive care unit acquired weakness: A prospective study

Objectives: To test the agreement between handgrip dynamometry and Medical Research Council (MRC) criteria for the diagnosis of intensive care unit acquired weakness (ICUAW) and to evaluate if dynamometry findings are associated with morbidity and mortality. Methods: A prospective single center cohort study was conducted in a Brazilian ICU. Adults requiring at least 5 days of critical care were included. Primary outcome was the agreement between ICUAW diagnosis as assessed by the MRC score and the handgrip strength dynamometry. Exploratory outcomes were in-ICU, in-hospital, 6-month and one-year mortality, days of mechanical ventilation, length of ICU and hospital stay (in the present hospitalization and during the 6-month follow-up) and ICU readmission in six months. Results: We included 45 consecutive subjects, of which 18 of them had ICUAW according to MRC criteria. Using sex specific thresholds, handgrip strength had high agreement with MRC criteria for ICUAW diagnosis (100% accuracy; Kappa coefficient = 1; p<0,001). ICUAW was associated with more days of mechanical ventilation, longer length of ICU stay and hospital stay in six months. There were no differences regarding mortality. Conclusions: Handgrip dynamometry may provide a simple and accurate alternative to the MRC examination for the diagnosis of ICUAW. ICUAW is associated with longer ICU and hospital stay and more requirement of mechanical ventilation.