Admission Handgrip Strength as an Independent Predictor of In-Hospital Mortality in Critically Ill Adults: A Prospective Observational Study

Background: Handgrip strength (HGS) is an emerging non-invasive biomarker that reflects neuromuscular integrity, physiological reserve, and nutritional status. While reduced HGS has been linked to adverse outcomes in various clinical populations, its prognostic value in critically ill ICU patients remains underexplored. Given these considerations, this study aims to rigorously evaluate the potential of admission HGS as a prognostic marker for in-hospital mortality among critically ill ICU patients. Methods: We conducted a prospective observational cohort study in a tertiary care ICU to evaluate whether the HGS at admission predicts in-hospital mortality. Adult patients (≥18 years) with evaluable HGS were included in the study. HGS was measured within 24 hours of admission using a standardized dynamometry protocol and expressed as sex-specific z scores. Multivariable penalized logistic regression was used to assess the association between HGS and mortality, adjusting for demographic, clinical, inflammatory (CRP), and renal (creatinine and urea) markers. The model performance was evaluated using the AUC, calibration plots, and Brier score. Results: A total of 200 patients from the ICU were enrolled; 98 (49.0%) died during hospitalization. Admission HGS was significantly lower among non-survivors (mean 4.7 ± 2.8 kg vs. 14.6 ± 4.8 kg, p