Handgrip Strength as a Predictor of Adverse Outcomes Among Older Adults in the Emergency Department

Handgrip Strength as a Predictor of Adverse Outcomes Among Older Adults in the Emergency Department | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Handgrip Strength as a Predictor of Adverse Outcomes Among Older Adults in the Emergency Department Sara Salini, Marcello Covino, Antonella Risoli, Riccardo Calvani, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7991518/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Sarcopenia and frailty are prevalent geriatric syndromes associated with adverse outcomes in older adults. Despite their clinical relevance, these conditions are rarely diagnosed or managed appropriately in emergency departments (EDs), where rapid decision-making is essential. Objective To investigate the prognostic value of handgrip strength (HGS) as a marker of probable sarcopenia and frailty in older adults admitted to the ED, and its association with in-hospital mortality and length of stay. Methods We conducted a retrospective observational study on patients aged ≥ 65 years admitted to a teaching hospital ED between January and December 2024. All patients underwent Comprehensive Geriatric Assessment, including Clinical Frailty Scale (CFS) and handgrip strength testing. Probable sarcopenia was defined according to EWGSOP2 cut-offs. Primary outcomes were in-hospital mortality and length of stay. Statistical analyses included multivariate Cox regression and Kaplan–Meier survival curves. Results Among 499 patients (median age 84 years), 88.2% met criteria for probable sarcopenia. In-hospital mortality occurred in 12.4% of cases and was significantly associated with lower HGS values (Day 1: p = 0.001; Day 3: p < 0.001; Day 7: p = 0.001). Patients with lower HGS also had higher CFS scores and increased prevalence of COPD, CKD, and sepsis. A handgrip strength below 7 kg was consistently associated with an adjusted hazard ratio above 1 for mortality, indicating elevated risk. Conclusion In the ED setting, handgrip strength is a simple, objective biomarker that correlates with frailty and predicts in-hospital mortality. Rather than focusing solely on diagnosing sarcopenia, integrating HGS into routine assessment may enhance risk stratification and guide personalized care for older adults. Figures Figure 1 1. INTRODUCTION Increased life expectancy has led to a significant demographic shift in the population presenting to emergency departments (EDs)¹. This growing cohort of older patients is often characterized by frailty—a clinical condition defined by diminished physiological reserve and reduced resilience to stressors—as well as sarcopenia²⁻⁴, a condition marked by decreased muscle strength⁵⁻⁶. These conditions increase the risk of both short- and long-term adverse outcomes, including prolonged hospitalization, in-hospital mortality, declining quality of life, and institutionalization⁷⁻⁹. Consequently, international guidelines now advocate for the implementation of frailty screening within the ED. This process holds significant potential to improve patient stratification, facilitate tailored care, and ultimately enhance clinical outcomes¹⁰. The diagnosis of sarcopenia, which is intrinsically linked to frailty, is confirmed by the presence of reduced muscle quantity or quality. The presence of low muscle strength, reduced muscle mass, and poor physical performance indicates severe sarcopenia¹¹. Sarcopenia is now recognized as a distinct disease with its own International Classification of Diseases (ICD)-10 code¹². In 2019, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) released an updated consensus on the definition and diagnosis of sarcopenia, identifying muscle strength as the primary domain for its evaluation¹¹. Sarcopenia has been associated with adverse hospital outcomes, including increased morbidity and mortality¹³. Therefore, as with frailty, early screening in the ED may help stratify patient risk and enable the timely implementation of preventive measures such as exercise, nutritional support, and supplementation¹⁴. In light of these considerations, there is growing scientific interest in developing comprehensive geriatric assessment tools¹⁵. The Geriatric Emergency Department Guidelines propose a multifaceted approach to the evaluation of older adults, emphasizing the implementation of screening procedures during ED visits¹⁶. These procedures include the identification of sarcopenia, delirium, fall risk and mobility issues, frailty, and home safety needs¹⁷⁻¹⁸. To be feasible in a fast-paced ED environment, these tools must be quick and easy to administer¹⁹⁻²⁰. Among them, handgrip strength measurement and the Clinical Frailty Scale (CFS)²¹ offer rapid assessment of muscle function for the diagnosis of probable sarcopenia and frailty. The Handgrip Test uses a dynamometer to measure grip strength, providing an objective and reproducible indicator of overall muscle function²². It is widely recognized as a biomarker of sarcopenia and functional capacity²³. The Clinical Frailty Scale (CFS) is a clinical tool that enables straightforward assessment of an older adult individual's frailty level, considering physical and cognitive status as well as independence in daily activities. The scale ranges from 1 (very fit) to 9 (terminally ill or completely dependent). It is particularly useful for estimating the risk of complications, hospitalizations, or mortality, and for guiding care and treatment decisions in geriatric or rehabilitation settings. Emerging evidence demonstrates a strong inverse correlation between handgrip strength and CFS scores: lower handgrip values are consistently associated with higher frailty levels, reflecting impaired resilience and accelerated functional decline²⁴. This relationship has significant prognostic implications, as individuals with both reduced handgrip strength and elevated CFS scores tend to experience worse clinical outcomes, including prolonged hospital stays, increased complication rates, greater risk of loss of independence, and higher mortality²⁵⁻²⁶. The combined use of CFS and handgrip strength assessment provides complementary information: while CFS captures the multidimensional construct of frailty, handgrip strength offers a sensitive quantitative biomarker of physical performance. Their integration into routine clinical practice may enhance risk stratification, guide personalized interventions such as nutritional support, resistance training, and rehabilitation programs, and ultimately improve clinical decision-making and patient outcomes. Geriatric assessment has the potential to facilitate the implementation of personalized interventions, ensuring that the most appropriate care is administered to each patient¹⁸. Understanding risk factors and stratification methodologies is essential to optimize the identification of adverse outcomes, including sarcopenia, in adult patients presenting to the ED¹⁹. The primary aim of this study is to evaluate the potential correlation between probable sarcopenia, as measured by handgrip strength, and in-hospital mortality and length of stay. The secondary aim is to identify clinical frailty scores, assessed via handgrip strength, that hold prognostic value for mortality in the emergency care setting. 2. MATERIALS AND METHODS 2.1. Study Design This is a prospective observational study conducted in the emergency department of a university hospital with a high percentage of adult patients (approximately 87%) and staffed by a geriatric team. We enrolled patients who arrived at the emergency department between January 2024 and December 2024. These patients were assessed using a Comprehensive Geriatric Assessment (CGA). Inclusion criteria: -patients with age ≥ 65 years -presence of Comprehensive Geriatric Assessment -hospitalization following the ED visit -absence of delirium Exclusion criteria: -age < 65 years -death in the ED -discharge -transfer to other hospitals -severe cognitive impairment 2.2. Study Variables Demographic characteristics (age and sex) and vital signs were collected for each patient. In the case of multiple measurements, the first values were considered. The Charlson Comorbidity Index 27 was used to objectively assess the degree of comorbidity. The conditions (including ischemic heart disease, heart failure, chronic obstructive pulmonary disease (COPD), peripheral artery disease, dementia, diabetes, chronic kidney disease, malignant neoplasm, and leukemia/lymphoma) were investigated during the medical history review. Each patient had blood samples taken for routine laboratory tests. We used the National Early Warning Score (NEWS) 28 at the time of admission to the emergency department to assess clinical severity. Patients were classified into three levels of clinical severity: low (green code, score 1 to 4), medium (yellow code, score 5 to 6), and high (red code, score ≥ 6). Each patient was evaluated by a geriatrician, who performed a Comprehensive Geriatric Assessment. The Clinical Frailty Scale (CFS) 21 was used to assess the frailty condition. Based on the CFS score, patients were classified as: Fit (CFS ≤ 3), mildly Mid Frail (CFS > 3 or ≤ 6), and Frail (CFS > 6). Probable sarcopenia was studied using the handgrip strength test (reference values HG > 27 for men, reference values HG > 16 for women) 22 . The grip strength test was measured on day 1 (triage admission) and on days 3 and 7 after admission. 2.3. Outcome Measures The primary endpoint of the study was the association between probable sarcopenia and in-hospital mortality and length of stay. The secondary outcome was the identification of any prognostic hand grip cut-offs specific to the emergency care setting. 2.4. Statistical Analysis Categorical variables are presented as absolute numbers and percentages; continuous variables are presented as median (interquartile range). Categorical variables were statistically compared by the Chi-square test or Fisher's exact test, as appropriate. Continuous variables were compared by the Mann–Whitney U test or, in the case of three or more groups, by the Wilcoxon ANOVA median test. Post hoc analysis was made by the Bonferroni test for multiple comparisons. Significant factors at univariate analysis were entered into a univariate and subsequently a multivariate logistic Cox model to identify independent risk factors for the defined endpoints. The variable of interest for the study (living arrangement) was forced in all the multivariate models. In the case of combined variables, such as single comorbidities and the Charlson Index, the composing factors were excluded from the analysis to avoid parameter overestimation and model instability. Similarly, the factors already considered in the analysis endpoint (such as RASS and delirium), were excluded from the multivariate model. According to these premises, a multivariate Cox regression model was used to determine the adjusted risk of in-hospital death for patients categorical. Survival curves were calculated according to the Kaplan–Meier method. Cox regression analysis results were reported as Hazard Ratio (HR) [95% confidence interval]. All p values were 2-sided, with a significance threshold set at 0.05, and corrected in the case of multiple group comparison. The study analysis was conducted by SPSS version 25 (IBM, Armonk, NY, USA). 3. RESULTS 3.1. Study population In the study period, 499 older adults were screened for Multidimensional Geriatric Assessment. The median age of the sample was 84 years [78–89], and 251 (50.3%) patients were male. According to frailty as determined by CFS, the Fit group consisted of 82 (16.4%) patients; the Mild Frail group was 329 (65.9%), and the Frail group was 88 (17.6%) patients. The most frequent presenting symptoms recorded in all groups were fever (39.9%), dyspnea (27.5%), syncope/fall (22.8%), and asthenia (18%). There were statistically significant differences in hand grip test values between patients with probable sarcopenia and those without probable sarcopenia in all measurements, both at time 0, three days and seven days (p value < 0.001). About comorbidities, the CCI median in the probable sarcopenia group was 6 [ 5 – 7 ] (p 0.001). In detail, patients with probable sarcopenia have more diagnoses of COPD (p value 0.01) and dementia (p value 0.003). Considering the symptoms, chest pain (p value < 0.001) and abdominal pain (p value 0.003) are more common in patients with probable sarcopenia. No statistically significant differences in laboratory test values. Regarding clinical severity at ED presentation, 437 (15.8) patients had a NEWS Score > 5, 1041 (37.6) a NEWS Score 3–5, and 1292 (46.6) a NEWS Score < 3. Regarding in-hospital mortality, 62 (12.4%) patients died during hospitalization, 3 (5.1) patients with no probable sarcopenia and 59 (13.4) patients with probable sarcopenia (p 0.07). The overall length of stay was higher among of probable sarcopenia group (12 [8.1–19.2) (p 0.388) (Table 1 ). Table 1 . Table 1 summarizes the characteristics of patients divided according Hand Grip value in patients with probable and no probable sarcopenia. The no probable sarcopenia group consisted of 59 patients; the probable sarcopenia group 440 patients. Variable All patients (n = 499) No Probable Sarcopenia (n = 59) Probable Sarcopenia (n = 440) P value Age, median (IQR) 84 [78–89] 77 [71–83] 84 [79–89] < 0.001 Male sex, No. (%) 251 (50.3) 31 (52.5) 220 (50) 0.71 BMI (IQR) 24.8 [22.8–27.6] 25.5 [23.4–27.8] 24.7 [22.6–27.6] 018 CFS, median (IQR) 5 [ 4 – 6 ] 4 [ 3 – 6 ] 5 [ 4 – 6 ] 0.005 Fit (CFS 1–3) 82 (16.4) 16 (27.1) 66 (15) Moder Frail (CFS 4–6) 329 (65.9) 38 (64.4) 291 (66.1) 0.02 Frail (CFS 7–9) 88 (17.6) 5 (8.5) 83 (18.9) CCI, median (IQR) 6 [ 4 – 6 ] 5 [ 3 – 6 ] 6 [ 5 – 7 ] 0.001 Assessment Hand Grip Day 1 (IQR) 11.7 [6.2–17 27.9 [17.4–31.1] 10.2 [5.8–15.7] < 0.001 Hand Grip Day 3 (IQR) 12.3 [ 7 – 18 ] 24 [18.1–30.6] 11.3 [6.5–16.3] < 0.001 Hand Grip Day 7 (IQR) 12.2 [7.5–18.2] 22.6 [17.2–31.2] 10.8 [6.9–16.7] < 0.001 Delta (Day 1- Day 3) (IQR) 2.9 [-8.5–20.1] 0.3 [-8.1–2.5] 4.1 [-8.5–22.7] 0.002 Delta (Day 1- Day 7) (IQR) 3.8 [-9.1–24.3] -1.4 [-14.9–3.4] 5.3 [-9.1–29.6] 0.001 Comorbidities, No. (%) Coronary artery disease 106 (21.2) 11 (18.6) 95 (21.6) 0.6 Heart failure 165 (33) 15 (25.4) 150 (34.1) 0.18 Peripheral vascular disease 49 (9.8) 5 (8.5) 44 (10) 0.71 Cerebrovascular disease 109 (21.8) 12 (20.3) 97 (22) 0.76 COPD 67 (13.4) 2 (3.4) 65 (14.8) 0.01 Liver cirrhosis 25 (5) 5 (8.5) 20 (4.5) 0.16 Diabetes mellitus 99 (19.8) 8 (13.6) 91 (20.7) 0.19 Neurological deficit 9 (1.8) 0 (0) 9 (2) 0.26 CKD 39 (7.8) 4 (6.8) 35 (8) 0.5 Solid tumor 86 (17.2) 11 (18.6) 75 (17) 0.44 Hematological tumors 9 (1.8) 0 (0) 9 (2) 0.27 Dementia 84 (16.8) 2 (3.4) 82 (18.6) 0.003 Symptoms, No. (%) Fever 189 (39.9) 25 (42.4) 164 (37.3) 0.45 Dyspnea 137 (27.5) 17 (28.8) 120 (27.3) 0.8 Chest pain 45 (9) 16 (27.1) 29 (6.6) < 0.001 Abdominal pain 105 (21) 21 (35.6) 84 (19.1) 0.003 Dysfagia 11 (2.2) 0 (0) 11 (2.5) 0.22 Asthenia 90 (18) 11 (18.6) 79 (18) 0.89 Syncope/Fall 114 (22.8) 12 (20.3) 102 (23.2) 0.62 Vital signs, median (IQR) Heart Rate, bpm 80 [68–89] 80 [69–80] 85 [66–100] 0.49 Systolic blood pressure, mmHg 131 [105–160] 125 [93–145] 144 [110–175] 0.24 Diastolic blood pressure, mmHg 70 [60–87] 67 [51–79] 72 [60–97] 0.16 SpO2, % 96 [95–99] 97 [95–99] 96 [95–98] 0.62 Body Temperature (°C) 36 [36–36.5] 36.3 [36–36.6] 36 [36–36.5] 0.30 Laboratory test, median (IQR) White blood cells, x10 9 /L 9.2 [7.2–12.5] 8.6 [7–17.4] 9.4 [7.4–12.3] 0.76 Haemoglobin (gr/dL) 12.2 [10.4–14.2] 12.4 [11.2–15.7] 12.2 [9.6–14.2] 0.36 Serum Creatinine (mg/dL) 1 [0.7–1.3] 1.1 [0.8–2.2] 1 [0.75–1.3] 0.23 Procalcitonin, ng/mL 0.17 [0.07–0.34] 0.39 [0.07–1.11] 0.16 [0.07–0.31] 0.536 C-reactive protein, mg/L 23 [8–120] 19 [3–48] 29 [9–144] 0.401 NEWS, No. (%) 0.52 1 39 (7.8) 4 (6.8) 35 (8) 2 244 (48.8) 33 (56) 211 (48) 3 216 (43.2) 22 (37.3) 194 (44.1) Length of stay, median (IQR), days 12 [ 8 – 19 ] 10.1 [8.1–17.4] 12 [8.1–19.2] 0.388 Length of stay in ER, median (IQR) 3 [ 2 – 4 ] 2.9 [1.9–4] 3 [2.1–3.9] 0.327 Mortality, No. (%) 62 (12.4) 3 (5.1) 59 (13.4) 0.07 CFS, clinical frailty scale; IQR, interquartile; CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; SpO2, Peripheral oxygen saturation; NEWS, National Early Warning Score 3.2. In-hospital mortality In the study cohort, 62 (12.4) patients died during hospitalization. Table 2 summarizes Clinical characteristics of enrolled patients according to mortality. Frailty condition was found to be correlated with mortality (p 0.001). Mortality was also related to Hand Grip value regardless of the day on which it is measured, Day 1 (p 0.001), Day 3 (p value < 0.001) or Day 7 (p value 0.001). In addition it is related to sepsis (p 0.002), COPD (p value 0.02), CKD (p value 0.03), dyspnea (p value 0.03). No statistically significant differences in laboratory test values compared alive to non-survivors. (Table 2 ). Table 2 Variable Survivors (n = 437) Non-survivors (n = 62) P value Age, median (IQR) 83 [77–88] 87 [81–93] 0.001 Male sex, No. (%) 220 (50,3) 31 (50) 0.96 BMI (IQR) 24,7 [ 22 , 8 – 27 , 7 ] 25 [ 22 , 2 – 26 , 9 ] 0.385 CFS, median (IQR) 5 [ 4 – 6 ] 6 [ 5 – 6 ] 0.001 Fit (CFS 1–3) 79 (18,1) 3 (4,8) Moder Frail (CFS 4–6) 285 (65,2) 44 (71) 0.02 Frail (CFS 7–9) 73 (16,7) 15 (24,2) CCI, median (IQR) 6 [ 4 – 7 ] 6[ 5 – 7 ] 0.27 Assessment Hand Grip Day 1 (IQR) 11,9 [ 6 , 7 – 18 , 5 ] 7,8 [ 3 , 2 – 14 , 3 ] 0.001 Hand Grip Day 3 (IQR) 13 [ 7 , 5 – 18 , 6 ] 7,4 [ 2 , 9 – 14 , 2 ] < 0.001 Hand Grip Day 7 (IQR) 12,8 [ 7 , 8 – 18 , 4 ] 8,9 [ 4 , 9 – 13 , 6 ] 0.001 Delta (Day 1- Day 3) (IQR) 4 [-4,5–21,3] -10,9 [-25,5 − 1,7] < 0.001 Delta (Day 1- Day 7) (IQR) 4,9 [-7,6–24] -8,9 [-37,6–46,2] 0.017 Sarcopenia, No. (%) 381 (87,2) 59 (95,2) 0.07 Comorbidities, No. (%) Coronary artery disease 98 (22,4) 8 (12,9) 0.09 Heart failure 139 (31,8) 26 (41,9) 0.11 Peripheral vascular disease 44 (10,1) 5 (8,1) 0.62 Cerebrovascular disease 100 (22,9) 9 (14,5) 0.13 COPD 52 (12,1) 14 (22,6) 0.02 Liver cirrhosis 20 (4,6) 6 (9,7) 0.72 Diabetes mellitus 92 (21,1) 7 (11,3) 0.07 Neurological deficit 9 (2,1) 0 (0) 0.25 CKD 30 (6,9) 9 (14,5) 0.03 Solid tumor 75 (17,2) 11 (17,7) 0.91 Hematological tumors 8 (1,8) 1 (1,6) 0.9 Dementia 71 (16,2) 13 (21) 0.35 Symptoms, No. (%) Fever 166 (38) 23 (37) 0.89 Dyspnea 113 (25,9) 24 (38,7) 0.03 Chest pain 41 (9,4) 4 (6,5) 0.45 Abdominal pain 93 (21,3) 12 (19,4) 0.73 Dysfagia 8 (1,8) 3 (4,8) 0.13 Asthenia 75 (17,2) 15 (24,2) 0.18 Syncope/Fall 99 (22,7) 15 (24,2) 0.79 Sepsis, No. (%) 41 (9,4) 14 (22,6) 0.002 Vital signs, median (IQR) Heart Rate, bpm 80 [67–87] 92 [80–92] 0.29 Systolic blood pressure, mmHg 131 [107–165] 107 [80–107] 0.38 Diastolic blood pressure, mmHg 70 [58–82] 74 [60–74] 0.85 SpO2, % 96 [95–98] 97 [96–97] 0.58 Body Temperature (°C) 36 [ 36 – 36 , 5 ] 36,5 [ 36 , 5 – 36 , 5 ] 0.23 Laboratory test, median (IQR) White blood cells, x10 9 /L 9,3 [ 7 , 4 – 12 , 5 ] 8,4 [ 4 , 7 – 15 , 2 ] 0.69 Haemoglobin (gr/dL) 12,9 [ 10 , 7 – 14 , 3 ] 11,5 [ 9 , 6 – 12 , 8 ] 0.71 Serum Creatinine (mg/dL) 1 [0,7 − 1,3] 2,1 [ 1 , 2 – 2 , 4 ] 0.048 Procalcitonin, ng/mL 0,17 [0,06 − 0,33] 0,36 [0,14 − 0,39] 0.5 C-reactive protein, mg/L 19 [5–141] 67 [29–74] 0.45 NEWS, No. (%) 0.26 1 34 (7,8) 5 (8,1) 2 208 (47,6) 36 (58,1) 3 195 (44,6) 21 (33,9) Length of stay, median (IQR), days 11 [ 8 – 18 ] 15 [ 8 – 19 ] 0.185 Length of stay in ER, median (IQR) 3 [ 2 – 4 ] 4 [ 3 – 4 ] 0.002 CFS, clinical frailty scale; IQR, interquartile; CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; SpO2, Peripheral oxygen saturation; NEWS, National Early Warning Score 3.3. In-hospital mortality according to Hand grip values According to Hand grip values, death probability was calculated by the beta values derived from a Cox proportional hazard multivariate model ( Cfr Fig. 1 ). The model was adjusted for Age and Charlson Index. Cubic spline with 3 knots was derived from calculated values in the study cohort (knots were placed at 25°, 50°, and 75° percentile). There is a non-linear inverse relationship between grip strength and the probability of in-hospital death in both sexes. As handgrip values increase, the probability of death decreases progressively, while below approximately 10 kg, the curve shows an exponential increase in risk. This association is more pronounced in women, who have a higher probability of in-hospital death than men with the same grip strength. In particular, in women with handgrip values below 10 kg, the estimated probability of death exceeds 40–50%, while in men with similar values it remains lower but still increasing, reaching values close to 30%. At higher handgrip values (> 25 kg), the probability of death remains below 10% in both sexes. These results indicate that reduced grip strength is an independent predictor of in-hospital mortality, with a more pronounced risk gradient in women. 4. DISCUSSION Sarcopenia is a geriatric syndrome with significant implications for clinical outcomes. A notable discrepancy exists between the literature and real-world practice, where this condition is rarely diagnosed according to established guidelines, and prevention or treatment strategies are seldom implemented²⁹. History-taking and physical examination are essential steps in identifying sarcopenic patients and recognizing risk factors for disease progression. Physician education through guidelines and structured training programs has been advocated to improve the management of sarcopenic patients³⁰,³¹. In practice, emergency departments are not equipped with dynamometers, and rapid screening tools such as the SARC-F questionnaire are not routinely used. Our findings reflect a targeted approach by physicians toward sarcopenic patients in the ED, yet without a preventive mindset. For instance, while vital signs were recorded in over 95% of patients³², sarcopenia was rarely investigated³³. Data from our study indicate that the prevalence of probable sarcopenia is higher than expected based on existing prevalence estimates in the population aged over 80. However, the “official cut-offs” for probable sarcopenia were not statistically correlated with in-hospital mortality or length of stay. One hypothesis is that sarcopenic patients are more frequently hospitalized³⁴,³⁵. Nevertheless, literature suggests that the highest prevalence of sarcopenia often results from prolonged hospitalization and is associated with nutritional status and duration of bed rest³⁶. Currently, reliable data on the prevalence of sarcopenia among ED patients are lacking, as muscle strength and body mass assessments are not part of routine emergency care. However, substantial evidence indicates that hospitalization can induce or accelerate sarcopenia, particularly in older and frail individuals³⁷. This condition, known as hospital-acquired sarcopenia, is exacerbated by immobility, acute inflammation, poor nutritional intake, and multiple comorbidities, leading to rapid muscle loss and strength decline, with negative consequences for functional recovery, length of stay, and overall prognosis³⁸,³⁹. It is therefore plausible that the higher prevalence of sarcopenia observed in our ED cohort reflects a broader concept of frailty. Sarcopenia has been proposed as a biological substrate of physical frailty⁴⁰ and as a pathway through which frailty-related outcomes manifest. Our findings may thus be explained by the convergence of multiple factors: sarcopenia, frailty, and the acute condition prompting ED admission. In this context, handgrip strength (HGS) emerges as a pivotal biomarker. Reduced HGS not only identifies sarcopenia but also correlates strongly with higher Clinical Frailty Scale (CFS) scores, reflecting diminished physiological reserve and increased vulnerability. While the CFS provides a multidimensional, albeit partly subjective, assessment of frailty, HGS offers an objective and quantitative parameter that reinforces clinical judgment and enhances prognostic accuracy⁴¹. The normative values proposed by EWGSOP2 do not account for variations related to age, ethnicity, body size, lifestyle, cultural background, clinical instability, or the care setting in which handgrip strength is measured¹¹. Underestimating probable sarcopenia may lead to missed opportunities for intervention and increased risk of adverse health outcomes. Accordingly, EWGSOP2 recommends the use of specific normative cut-offs when available⁴². Several studies have highlighted the need to establish modified normative values based on real-world data specific to the population under analysis. For example, a handgrip strength value of 28 kg in a young man would be considered ‘normal’ according to EWGSOP2 and the Foundation for the National Institutes of Health Sarcopenia Project¹¹. However, when analyzing homogeneous populations (e.g., by age) and distributing values into percentiles, such a value may fall around the 5th percentile for age and sex, indicating likely sarcopenia⁶. Other studies have shown that using population-specific cut-offs (e.g., 35/20 kg) compared to lower thresholds derived from British cohorts prevented underdiagnosis of probable sarcopenia in 25.3% of study participants⁴³. As suggested by EWGSOP2²² and verified in younger populations or adjusted for ethnicity and other variables, the identification of specific normative cut-offs for frailty and sarcopenia is also necessary for patients in the emergency department. Our analysis revealed a clear inverse association between handgrip strength and in-hospital mortality risk. The red curve in Fig. 1 represents the adjusted hazard ratio for hospital mortality as a function of handgrip strength, with dotted lines indicating the 95% confidence interval. The blue horizontal line corresponds to the reference value (HR = 1). As shown, lower handgrip values are associated with an adjusted hazard ratio significantly above 1, indicating increased mortality risk. Conversely, higher grip strength values are associated with a progressive reduction in hazard ratio, approaching the reference value, suggesting a protective effect. Specifically, handgrip values below 10 kg are consistently associated with hazard ratios above the reference, indicating a higher probability of death during hospitalization. In contrast, values above 10 kg are linked to a lower risk, comparable to the average, suggesting that preserved muscle strength is a protective factor against in-hospital mortality. 5. CONCLUSIONS Within the emergency department setting, the formal diagnosis of probable sarcopenia may not be of primary importance. A more effective strategy may involve utilizing handgrip strength values to identify broader frailty or predict adverse outcomes. To support this approach, it is imperative to increase the availability of real-world data, thereby enabling the establishment of normative values tailored to the emergency care environment. Declarations Author Contributions: Conceptualization, F.F. and F.L.; methodology, R.C., S.S., F.C.; software, R.C., C.M., and C.R.; validation, M.C.; formal analysis, M.C.; investigation, S.C., A.R., C.M., and V.I.; resources, F.F. and G.D.M.; data curation, M.C.; writing—original draft preparation, S.S. and C.M.; writing—review and editing, S.S. and A.R.; visualization, V.I. and F.C.; supervision, A.R. and F.F.; project administration, F.F. and F.L. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Human Ethics and Consent to Participate declarations: The study was conducted according to the principles expressed in the Declaration of Helsinki and its later amendments. It was approved by the Fondazione Policlinico Universitario A. Gemelli, IRCCS Institutional Review Board (‘Differenze di età e genere nell’accesso al Pronto Soccorso’ - 0025817/22, approval date 03/08/2022 - Clinical trial number: ID NCT05593692). Every patient involved in the study signed a Consent to Participate. Data Availability Statement: The data presented in this study are available upon reasonable requests made relative to the corresponding author. Conflicts of Interest: The authors declare no conflicts of interest. References Pallin DJ, Allen MB, Espinola JA, Camargo CA, Bohan JS. Population aging and emergency departments: visits will not increase, lengths-of-stay and hospitalizations will. Health Aff (Millwood). 2013;32(7):1306–12. 10.1377/hlthaff.2012.0951 . Preston L, van Oppen JD, Conroy SP, Ablard S, Buckley Woods H, Mason SM. Improving outcomes for older people in the emergency department: a review of reviews. Emerg Med J. 2021;38(12):882–8. 10.1136/emermed-2020-209514 . Šteinmiller J, Routasalo P, Suominen T. Older people in the emergency department: a literature review. Int J Older People Nurs. 2015;10(4):284–305. 10.1111/opn.12090 . Sato R, Vatic M, Peixoto da Fonseca GW, Anker SD, von Haehling S. Biological basis and treatment of frailty and sarcopenia. Cardiovasc Res. 2024;120(9):982–98. 10.1093/cvr/cvae073 . Landi F, Calvani R, Tosato M, et al. Age-Related Variations of Muscle Mass, Strength, and Physical Performance in Community-Dwellers: Results From the Milan EXPO Survey. J Am Med Dir Assoc. 2017;18(1):88. .e17-88.e24. Landi F, Calvani R, Martone AM, et al. Normative values of muscle strength across ages in a real world population: results from the longevity check-up 7 + project. J Cachexia Sarcopenia Muscle. 2020;11(6):1562–9. 10.1002/jcsm.12610 . Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc. 2016;17(12):1163. .e1-1163.e17. Clegg A, Young J. The frailty syndrome. Clin Med. 2011;11(1):72–5. 10.7861/clinmedicine.11-1-72 . Liao M-C, Yen C-C, Lin Y-T, Huang F-D, Chang Y-T. Sarcopenia is associated with mortality in non-critical elderly patients visiting the emergency department. Front Med. 2022;9:1027503. 10.3389/fmed.2022.1027503 . Lee H, Lee E, Jang IY. Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci. 2020;35(3):e16. 10.3346/jkms.2020.35.e16 . Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. 10.1093/ageing/afy169 . Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle. 2016;7(5):512–4. 10.1002/jcsm.12147 . Xu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis. Gerontology. 2022;68(4):361–76. 10.1159/000517099 . Bai W, Ge H, Han H, Xu J, Qin L. Association of frailty and sarcopenia with short-term mortality in older critically ill patients. J Nutr Health Aging. 2024;28(8):100321. 10.1016/j.jnha.2024.100321 . Salini S, Giovannini S, Covino M, et al. Frailty Network in an Acute Care Setting: The New Perspective for Frail Older People. Diagnostics (Basel Switzerland). 2022;12(5). 10.3390/diagnostics12051228 . american college of emergency physicians. GERIATRIC EMERGENCY DEPARTMENT GUIDELINES .; 2013. Pachołek K, Sobieszczańska M. Sarcopenia Identification during Comprehensive Geriatric Assessment. Int J Environ Res Public Health. 2021;19(1). 10.3390/ijerph19010032 . Blumer J, Le B. Rethinking sarcopenia and frailty of the elderly. Post Reprod Heal. 2025;31(3):184–7. 10.1177/20533691251337173 . O’Shaughnessy Í, Romero-Ortuno R, Edge L, et al. Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med. 2021;85:50–5. 10.1016/j.ejim.2020.11.015 . Salini S, Russo A, Calvani R, et al. Self-reported difficulty in walking 400 meters: the red flag for probable sarcopenia. BMC Geriatr. 2022;22(1):530. 10.1186/s12877-022-03231-z . Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. 10.1503/cmaj.050051 . Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clin Interv Aging. 2019;14:1681–91. 10.2147/CIA.S194543 . Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet (London England). 2015;386(9990):266–73. 10.1016/S0140-6736(14)62000-6 . Dodds RM, Syddall HE, Cooper R, Kuh D, Cooper C, Sayer AA. Global variation in grip strength: a systematic review and meta-analysis of normative data. Age Ageing. 2016;45(2):209–16. 10.1093/ageing/afv192 . Chainani V, Shaharyar S, Dave K, et al. Objective measures of the frailty syndrome (hand grip strength and gait speed) and cardiovascular mortality: A systematic review. Int J Cardiol. 2016;215:487–93. 10.1016/j.ijcard.2016.04.068 . Ida S, Kaneko R, Imataka K, Murata K. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol. 2019;18(1):81. 10.1186/s12933-019-0885-2 . Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51. 10.1016/0895-4356(94)90129-5 . Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465–70. 10.1016/J.RESUSCITATION.2012.12.016 . Aldrich L, Ispoglou T, Prokopidis K, Alqallaf J, Wilson O, Stavropoulos-Kalinoglou A. Acute Sarcopenia: Systematic Review and Meta-Analysis on Its Incidence and Muscle Parameter Shifts During Hospitalisation. J Cachexia Sarcopenia Muscle. 2025;16(1):e13662. 10.1002/jcsm.13662 . Ackermans LLGC, Rabou J, Basrai M, et al. Screening, diagnosis and monitoring of sarcopenia: When to use which tool? Clin Nutr ESPEN. 2022;48:36–44. 10.1016/j.clnesp.2022.01.027 . Xian X, Zhang J, Yang H. A review of the status of sarcopenia in elderly hospitalized patients. Med (Baltim). 2025;104(28):e43365. 10.1097/MD.0000000000043365 . Covino M, Sandroni C, Della Polla D, et al. Predicting ICU admission and death in the Emergency Department: A comparison of six early warning scores. Resuscitation. 2023;190:109876. 10.1016/j.resuscitation.2023.109876 . Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249–56. 10.1016/j.jamda.2011.01.003 . Martinez BP, Batista AKMS, Gomes IB, Olivieri FM, Camelier FWR, Camelier AA. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC Musculoskelet Disord. 2015;16:108. 10.1186/s12891-015-0570-x . Smoliner C, Sieber CC, Wirth R. Prevalence of sarcopenia in geriatric hospitalized patients. J Am Med Dir Assoc. 2014;15(4):267–72. 10.1016/j.jamda.2013.11.027 . Martone AM, Bianchi L, Abete P, et al. The incidence of sarcopenia among hospitalized older patients: results from the Glisten study. J Cachexia Sarcopenia Muscle. 2017;8(6):907–14. 10.1002/jcsm.12224 . Kortebein P, Symons TB, Ferrando A, et al. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol Biol Sci Med Sci. 2008;63(10):1076–81. 10.1093/gerona/63.10.1076 . Lipnicki DM, Gunga H-C. Physical inactivity and cognitive functioning: results from bed rest studies. Eur J Appl Physiol. 2009;105(1):27–35. 10.1007/s00421-008-0869-5 . Liu J, Xue H, Ma Y-H, Wang Z. Acute muscle loss in elderly hospitalized patients: Risk factors and adverse clinical outcomes. Geriatr Nurs. 2025;61:449–54. 10.1016/j.gerinurse.2024.12.032 . Landi F, Calvani R, Cesari M, et al. Sarcopenia as the Biological Substrate of Physical Frailty. Clin Geriatr Med. 2015;31(3):367–74. 10.1016/j.cger.2015.04.005 . Kaeppeli T, Rueegg M, Dreher-Hummel T, et al. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med. 2020;76(3):291–300. 10.1016/j.annemergmed.2020.03.028 . Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601. 10.1093/ageing/afz046 . Bahat G, Kilic C, Altinkaynak M, Akif Karan M. Comparison of standard versus population-specific handgrip strength cut-off points in the detection of probable sarcopenia after launch of EWGSOP2. Aging Male. 2020;23(5):1564–9. 10.1080/13685538.2020.1870038 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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INTRODUCTION","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIncreased life expectancy has led to a significant demographic shift in the population presenting to emergency departments (EDs)\u0026sup1;. This growing cohort of older patients is often characterized by frailty\u0026mdash;a clinical condition defined by diminished physiological reserve and reduced resilience to stressors\u0026mdash;as well as sarcopenia\u0026sup2;⁻⁴, a condition marked by decreased muscle strength⁵⁻⁶. These conditions increase the risk of both short- and long-term adverse outcomes, including prolonged hospitalization, in-hospital mortality, declining quality of life, and institutionalization⁷⁻⁹.\u003c/p\u003e\u003cp\u003e Consequently, international guidelines now advocate for the implementation of frailty screening within the ED. This process holds significant potential to improve patient stratification, facilitate tailored care, and ultimately enhance clinical outcomes\u0026sup1;⁰.\u003c/p\u003e\u003cp\u003eThe diagnosis of sarcopenia, which is intrinsically linked to frailty, is confirmed by the presence of reduced muscle quantity or quality. The presence of low muscle strength, reduced muscle mass, and poor physical performance indicates severe sarcopenia\u0026sup1;\u0026sup1;. Sarcopenia is now recognized as a distinct disease with its own International Classification of Diseases (ICD)-10 code\u0026sup1;\u0026sup2;. In 2019, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) released an updated consensus on the definition and diagnosis of sarcopenia, identifying muscle strength as the primary domain for its evaluation\u0026sup1;\u0026sup1;.\u003c/p\u003e\u003cp\u003eSarcopenia has been associated with adverse hospital outcomes, including increased morbidity and mortality\u0026sup1;\u0026sup3;. Therefore, as with frailty, early screening in the ED may help stratify patient risk and enable the timely implementation of preventive measures such as exercise, nutritional support, and supplementation\u0026sup1;⁴. In light of these considerations, there is growing scientific interest in developing comprehensive geriatric assessment tools\u0026sup1;⁵.\u003c/p\u003e\u003cp\u003e The Geriatric Emergency Department Guidelines propose a multifaceted approach to the evaluation of older adults, emphasizing the implementation of screening procedures during ED visits\u0026sup1;⁶. These procedures include the identification of sarcopenia, delirium, fall risk and mobility issues, frailty, and home safety needs\u0026sup1;⁷⁻\u0026sup1;⁸.\u003c/p\u003e\u003cp\u003eTo be feasible in a fast-paced ED environment, these tools must be quick and easy to administer\u0026sup1;⁹⁻\u0026sup2;⁰. Among them, handgrip strength measurement and the Clinical Frailty Scale (CFS)\u0026sup2;\u0026sup1; offer rapid assessment of muscle function for the diagnosis of probable sarcopenia and frailty. The Handgrip Test uses a dynamometer to measure grip strength, providing an objective and reproducible indicator of overall muscle function\u0026sup2;\u0026sup2;. It is widely recognized as a biomarker of sarcopenia and functional capacity\u0026sup2;\u0026sup3;.\u003c/p\u003e\u003cp\u003eThe Clinical Frailty Scale (CFS) is a clinical tool that enables straightforward assessment of an older adult individual's frailty level, considering physical and cognitive status as well as independence in daily activities. The scale ranges from 1 (very fit) to 9 (terminally ill or completely dependent). It is particularly useful for estimating the risk of complications, hospitalizations, or mortality, and for guiding care and treatment decisions in geriatric or rehabilitation settings.\u003c/p\u003e\u003cp\u003eEmerging evidence demonstrates a strong inverse correlation between handgrip strength and CFS scores: lower handgrip values are consistently associated with higher frailty levels, reflecting impaired resilience and accelerated functional decline\u0026sup2;⁴. This relationship has significant prognostic implications, as individuals with both reduced handgrip strength and elevated CFS scores tend to experience worse clinical outcomes, including prolonged hospital stays, increased complication rates, greater risk of loss of independence, and higher mortality\u0026sup2;⁵⁻\u0026sup2;⁶.\u003c/p\u003e\u003cp\u003eThe combined use of CFS and handgrip strength assessment provides complementary information: while CFS captures the multidimensional construct of frailty, handgrip strength offers a sensitive quantitative biomarker of physical performance. Their integration into routine clinical practice may enhance risk stratification, guide personalized interventions such as nutritional support, resistance training, and rehabilitation programs, and ultimately improve clinical decision-making and patient outcomes.\u003c/p\u003e\u003cp\u003eGeriatric assessment has the potential to facilitate the implementation of personalized interventions, ensuring that the most appropriate care is administered to each patient\u0026sup1;⁸. Understanding risk factors and stratification methodologies is essential to optimize the identification of adverse outcomes, including sarcopenia, in adult patients presenting to the ED\u0026sup1;⁹.\u003c/p\u003e\u003cp\u003eThe primary aim of this study is to evaluate the potential correlation between probable sarcopenia, as measured by handgrip strength, and in-hospital mortality and length of stay. The secondary aim is to identify clinical frailty scores, assessed via handgrip strength, that hold prognostic value for mortality in the emergency care setting.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003e2.1. Study Design\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eThis is a prospective observational study conducted in the emergency department of a university hospital with a high percentage of adult patients (approximately 87%) and staffed by a geriatric team. We enrolled patients who arrived at the emergency department between January 2024 and December 2024. These patients were assessed using a Comprehensive Geriatric Assessment (CGA).\u003c/p\u003e\n \u003cp\u003eInclusion criteria:\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e-patients with age ≥ 65 years\u003c/p\u003e\n \u003cp\u003e-presence of Comprehensive Geriatric Assessment\u003c/p\u003e\n \u003cp\u003e-hospitalization following the ED visit\u003c/p\u003e\n \u003cp\u003e-absence of delirium\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003eExclusion criteria:\u003c/p\u003e\n \u003c/div\u003e-age \u0026lt; 65 years\u003cp\u003e-death in the ED\u003c/p\u003e\n \u003cp\u003e-discharge\u003c/p\u003e\n \u003cp\u003e-transfer to other hospitals\u003c/p\u003e\n \u003cp\u003e-severe cognitive impairment\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003e2.2. Study Variables\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic characteristics (age and sex) and vital signs were collected for each patient. In the case of multiple measurements, the first values were considered.\u003c/p\u003e\n \u003cp\u003eThe Charlson Comorbidity Index\u003csup\u003e27\u003c/sup\u003e was used to objectively assess the degree of comorbidity. The conditions (including ischemic heart disease, heart failure, chronic obstructive pulmonary disease (COPD), peripheral artery disease, dementia, diabetes, chronic kidney disease, malignant neoplasm, and leukemia/lymphoma) were investigated during the medical history review. Each patient had blood samples taken for routine laboratory tests.\u003c/p\u003e\n \u003cp\u003eWe used the National Early Warning Score (NEWS)\u003csup\u003e28\u003c/sup\u003e at the time of admission to the emergency department to assess clinical severity. Patients were classified into three levels of clinical severity: low (green code, score 1 to 4), medium (yellow code, score 5 to 6), and high (red code, score ≥ 6).\u003c/p\u003e\n \u003cp\u003eEach patient was evaluated by a geriatrician, who performed a Comprehensive Geriatric Assessment. The Clinical Frailty Scale (CFS)\u003csup\u003e21\u003c/sup\u003e was used to assess the frailty condition. Based on the CFS score, patients were classified as: Fit (CFS ≤ 3), mildly Mid Frail (CFS \u0026gt; 3 or ≤ 6), and Frail (CFS \u0026gt; 6).\u003c/p\u003e\n \u003cp\u003eProbable sarcopenia was studied using the handgrip strength test (reference values HG \u0026gt; 27 for men, reference values HG \u0026gt; 16 for women)\u003csup\u003e22\u003c/sup\u003e. The grip strength test was measured on day 1 (triage admission) and on days 3 and 7 after admission.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003e2.3. Outcome Measures\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eThe primary endpoint of the study was the association between probable sarcopenia and in-hospital mortality and length of stay. The secondary outcome was the identification of any prognostic hand grip cut-offs specific to the emergency care setting.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003e2.4. Statistical Analysis\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eCategorical variables are presented as absolute numbers and percentages; continuous variables are presented as median (interquartile range). Categorical variables were statistically compared by the Chi-square test or Fisher's exact test, as appropriate. Continuous variables were compared by the Mann–Whitney U test or, in the case of three or more groups, by the Wilcoxon ANOVA median test. Post hoc analysis was made by the Bonferroni test for multiple comparisons.\u003c/p\u003e\n \u003cp\u003eSignificant factors at univariate analysis were entered into a univariate and subsequently a multivariate logistic Cox model to identify independent risk factors for the defined endpoints. The variable of interest for the study (living arrangement) was forced in all the multivariate models.\u003c/p\u003e\n \u003cp\u003eIn the case of combined variables, such as single comorbidities and the Charlson Index, the composing factors were excluded from the analysis to avoid parameter overestimation and model instability. Similarly, the factors already considered in the analysis endpoint (such as RASS and delirium), were excluded from the multivariate model.\u003c/p\u003e\n \u003cp\u003eAccording to these premises, a multivariate Cox regression model was used to determine the adjusted risk of in-hospital death for patients categorical. Survival curves were calculated according to the Kaplan–Meier method. Cox regression analysis results were reported as Hazard Ratio (HR) [95% confidence interval].\u003c/p\u003e\n \u003cp\u003eAll p values were 2-sided, with a significance threshold set at 0.05, and corrected in the case of multiple group comparison. The study analysis was conducted by SPSS version 25 (IBM, Armonk, NY, USA).\u003c/p\u003e\n \u003c/div\u003e\n\n\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Study population\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn the study period, 499 older adults were screened for Multidimensional Geriatric Assessment. The median age of the sample was 84 years [78\u0026ndash;89], and 251 (50.3%) patients were male.\u003c/p\u003e \u003cp\u003eAccording to frailty as determined by CFS, the Fit group consisted of 82 (16.4%) patients; the Mild Frail group was 329 (65.9%), and the Frail group was 88 (17.6%) patients.\u003c/p\u003e \u003cp\u003eThe most frequent presenting symptoms recorded in all groups were fever (39.9%), dyspnea (27.5%), syncope/fall (22.8%), and asthenia (18%).\u003c/p\u003e \u003cp\u003eThere were statistically significant differences in hand grip test values between patients with probable sarcopenia and those without probable sarcopenia in all measurements, both at time 0, three days and seven days (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAbout comorbidities, the CCI median in the probable sarcopenia group was 6 [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] (p 0.001).\u003c/p\u003e \u003cp\u003eIn detail, patients with probable sarcopenia have more diagnoses of COPD (p value 0.01) and dementia (p value 0.003).\u003c/p\u003e \u003cp\u003eConsidering the symptoms, chest pain (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and abdominal pain (p value 0.003) are more common in patients with probable sarcopenia.\u003c/p\u003e \u003cp\u003eNo statistically significant differences in laboratory test values.\u003c/p\u003e \u003cp\u003eRegarding clinical severity at ED presentation, 437 (15.8) patients had a NEWS Score\u0026thinsp;\u0026gt;\u0026thinsp;5, 1041 (37.6) a NEWS Score 3\u0026ndash;5, and 1292 (46.6) a NEWS Score\u0026thinsp;\u0026lt;\u0026thinsp;3.\u003c/p\u003e \u003cp\u003eRegarding in-hospital mortality, 62 (12.4%) patients died during hospitalization, 3 (5.1) patients with no probable sarcopenia and 59 (13.4) patients with probable sarcopenia (p 0.07). The overall length of stay was higher among of probable sarcopenia group (12 [8.1\u0026ndash;19.2) (p 0.388) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003esummarizes the characteristics of patients divided according Hand Grip value in patients with probable and no probable sarcopenia. The no probable sarcopenia group consisted of 59 patients; the probable sarcopenia group 440 patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;499)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Probable\u003c/p\u003e \u003cp\u003eSarcopenia (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProbable\u003c/p\u003e \u003cp\u003eSarcopenia\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;440)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 [78\u0026ndash;89]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 [71\u0026ndash;83]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 [79\u0026ndash;89]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251 (50.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.8 [22.8\u0026ndash;27.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.5 [23.4\u0026ndash;27.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.7 [22.6\u0026ndash;27.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFS, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFit (CFS 1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModer Frail (CFS 4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e329 (65.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (64.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e291 (66.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrail (CFS 7\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssessment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand Grip Day 1 (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.7 [6.2\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.9 [17.4\u0026ndash;31.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.2 [5.8\u0026ndash;15.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand Grip Day 3 (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.3 [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 [18.1\u0026ndash;30.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.3 [6.5\u0026ndash;16.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand Grip Day 7 (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.2 [7.5\u0026ndash;18.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.6 [17.2\u0026ndash;31.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8 [6.9\u0026ndash;16.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelta (Day 1- Day 3) (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 [-8.5\u0026ndash;20.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.3 [-8.1\u0026ndash;2.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1 [-8.5\u0026ndash;22.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelta (Day 1- Day 7) (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8 [-9.1\u0026ndash;24.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.4 [-14.9\u0026ndash;3.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.3 [-9.1\u0026ndash;29.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidities, No. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106 (21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165 (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral vascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver cirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological deficit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematological tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms, No. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (42.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (35.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysfagia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSyncope/Fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVital signs, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart Rate, bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 [68\u0026ndash;89]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 [69\u0026ndash;80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 [66\u0026ndash;100]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 [105\u0026ndash;160]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 [93\u0026ndash;145]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 [110\u0026ndash;175]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic blood pressure, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 [60\u0026ndash;87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 [51\u0026ndash;79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 [60\u0026ndash;97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpO2, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 [95\u0026ndash;99]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 [95\u0026ndash;99]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 [95\u0026ndash;98]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Temperature (\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 [36\u0026ndash;36.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.3 [36\u0026ndash;36.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 [36\u0026ndash;36.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory test, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cells, x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.2 [7.2\u0026ndash;12.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.6 [7\u0026ndash;17.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.4 [7.4\u0026ndash;12.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaemoglobin (gr/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.2 [10.4\u0026ndash;14.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.4 [11.2\u0026ndash;15.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.2 [9.6\u0026ndash;14.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Creatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 [0.7\u0026ndash;1.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1 [0.8\u0026ndash;2.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 [0.75\u0026ndash;1.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcalcitonin, ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.17 [0.07\u0026ndash;0.34]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39 [0.07\u0026ndash;1.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16 [0.07\u0026ndash;0.31]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein, mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 [8\u0026ndash;120]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 [3\u0026ndash;48]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 [9\u0026ndash;144]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNEWS, No. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e244 (48.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e211 (48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e194 (44.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of stay, median (IQR), days\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1 [8.1\u0026ndash;17.4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 [8.1\u0026ndash;19.2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of stay in ER, median (IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9 [1.9\u0026ndash;4]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 [2.1\u0026ndash;3.9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMortality, No. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCFS, clinical frailty scale; IQR, interquartile; CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; SpO2, Peripheral oxygen saturation; NEWS, National Early Warning Score\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. In-hospital mortality\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn the study cohort, 62 (12.4) patients died during hospitalization. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes Clinical characteristics of enrolled patients according to mortality.\u003c/p\u003e \u003cp\u003eFrailty condition was found to be correlated with mortality (p 0.001).\u003c/p\u003e \u003cp\u003eMortality was also related to Hand Grip value regardless of the day on which it is measured, Day 1 (p 0.001), Day 3 (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or Day 7 (p value 0.001).\u003c/p\u003e \u003cp\u003eIn addition it is related to sepsis (p 0.002), COPD (p value 0.02), CKD (p value 0.03), dyspnea (p value 0.03).\u003c/p\u003e \u003cp\u003eNo statistically significant differences in laboratory test values compared alive to non-survivors. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvivors (n\u0026thinsp;=\u0026thinsp;437)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-survivors (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 [77\u0026ndash;88]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 [81\u0026ndash;93]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220 (50,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24,7 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFS, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFit (CFS 1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (18,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModer Frail (CFS 4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e285 (65,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrail (CFS 7\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (16,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (24,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand Grip Day 1 (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11,9 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,8 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand Grip Day 3 (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7,4 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand Grip Day 7 (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12,8 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,9 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelta (Day 1- Day 3) (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [-4,5\u0026ndash;21,3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-10,9 [-25,5\u0026thinsp;\u0026minus;\u0026thinsp;1,7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelta (Day 1- Day 7) (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,9 [-7,6\u0026ndash;24]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-8,9 [-37,6\u0026ndash;46,2]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSarcopenia, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e381 (87,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (95,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (22,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (12,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (31,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (41,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeripheral vascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (10,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (22,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (14,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (12,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (22,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver cirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (4,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (9,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (21,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (11,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological deficit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (2,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (6,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (14,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (17,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (17,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematological tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (1,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (16,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e166 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (25,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (38,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (9,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (6,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (21,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (19,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysfagia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (1,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsthenia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (17,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (24,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSyncope/Fall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (22,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (24,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (9,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (22,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVital signs, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart Rate, bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 [67\u0026ndash;87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 [80\u0026ndash;92]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 [107\u0026ndash;165]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 [80\u0026ndash;107]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic blood pressure, mmHg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 [58\u0026ndash;82]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 [60\u0026ndash;74]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpO2, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 [95\u0026ndash;98]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 [96\u0026ndash;97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Temperature (\u0026deg;C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36,5 [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory test, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cells, x10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9,3 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8,4 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13 CR14\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaemoglobin (gr/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12,9 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12 CR13\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,5 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Creatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 [0,7\u0026thinsp;\u0026minus;\u0026thinsp;1,3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,1 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcalcitonin, ng/mL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,17 [0,06\u0026thinsp;\u0026minus;\u0026thinsp;0,33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,36 [0,14\u0026thinsp;\u0026minus;\u0026thinsp;0,39]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein, mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 [5\u0026ndash;141]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 [29\u0026ndash;74]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNEWS, No. (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (7,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208 (47,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (58,1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e195 (44,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (33,9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, median (IQR), days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay in ER, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCFS, clinical frailty scale; IQR, interquartile; CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; SpO2, Peripheral oxygen saturation; NEWS, National Early Warning Score\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3. In-hospital mortality according to Hand grip values\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAccording to Hand grip values, death probability was calculated by the beta values derived from a Cox proportional hazard multivariate model (\u003cem\u003eCfr Fig.\u0026nbsp;1\u003c/em\u003e). The model was adjusted for Age and Charlson Index. Cubic spline with 3 knots was derived from calculated values in the study cohort (knots were placed at 25\u0026deg;, 50\u0026deg;, and 75\u0026deg; percentile).\u003c/p\u003e \u003cp\u003eThere is a non-linear inverse relationship between grip strength and the probability of in-hospital death in both sexes. As handgrip values increase, the probability of death decreases progressively, while below approximately 10 kg, the curve shows an exponential increase in risk. This association is more pronounced in women, who have a higher probability of in-hospital death than men with the same grip strength.\u003c/p\u003e \u003cp\u003eIn particular, in women with handgrip values below 10 kg, the estimated probability of death exceeds 40\u0026ndash;50%, while in men with similar values it remains lower but still increasing, reaching values close to 30%. At higher handgrip values (\u0026gt;\u0026thinsp;25 kg), the probability of death remains below 10% in both sexes.\u003c/p\u003e \u003cp\u003eThese results indicate that reduced grip strength is an independent predictor of in-hospital mortality, with a more pronounced risk gradient in women.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSarcopenia is a geriatric syndrome with significant implications for clinical outcomes. A notable discrepancy exists between the literature and real-world practice, where this condition is rarely diagnosed according to established guidelines, and prevention or treatment strategies are seldom implemented\u0026sup2;⁹.\u003c/p\u003e\u003cp\u003eHistory-taking and physical examination are essential steps in identifying sarcopenic patients and recognizing risk factors for disease progression. Physician education through guidelines and structured training programs has been advocated to improve the management of sarcopenic patients\u0026sup3;⁰,\u0026sup3;\u0026sup1;.\u003c/p\u003e\u003cp\u003eIn practice, emergency departments are not equipped with dynamometers, and rapid screening tools such as the SARC-F questionnaire are not routinely used. Our findings reflect a targeted approach by physicians toward sarcopenic patients in the ED, yet without a preventive mindset. For instance, while vital signs were recorded in over 95% of patients\u0026sup3;\u0026sup2;, sarcopenia was rarely investigated\u0026sup3;\u0026sup3;.\u003c/p\u003e\u003cp\u003eData from our study indicate that the prevalence of probable sarcopenia is higher than expected based on existing prevalence estimates in the population aged over 80. However, the \u0026ldquo;official cut-offs\u0026rdquo; for probable sarcopenia were not statistically correlated with in-hospital mortality or length of stay.\u003c/p\u003e\u003cp\u003eOne hypothesis is that sarcopenic patients are more frequently hospitalized\u0026sup3;⁴,\u0026sup3;⁵. Nevertheless, literature suggests that the highest prevalence of sarcopenia often results from prolonged hospitalization and is associated with nutritional status and duration of bed rest\u0026sup3;⁶.\u003c/p\u003e\u003cp\u003eCurrently, reliable data on the prevalence of sarcopenia among ED patients are lacking, as muscle strength and body mass assessments are not part of routine emergency care. However, substantial evidence indicates that hospitalization can induce or accelerate sarcopenia, particularly in older and frail individuals\u0026sup3;⁷. This condition, known as hospital-acquired sarcopenia, is exacerbated by immobility, acute inflammation, poor nutritional intake, and multiple comorbidities, leading to rapid muscle loss and strength decline, with negative consequences for functional recovery, length of stay, and overall prognosis\u0026sup3;⁸,\u0026sup3;⁹.\u003c/p\u003e\u003cp\u003eIt is therefore plausible that the higher prevalence of sarcopenia observed in our ED cohort reflects a broader concept of frailty. Sarcopenia has been proposed as a biological substrate of physical frailty⁴⁰ and as a pathway through which frailty-related outcomes manifest. Our findings may thus be explained by the convergence of multiple factors: sarcopenia, frailty, and the acute condition prompting ED admission.\u003c/p\u003e\u003cp\u003eIn this context, handgrip strength (HGS) emerges as a pivotal biomarker. Reduced HGS not only identifies sarcopenia but also correlates strongly with higher Clinical Frailty Scale (CFS) scores, reflecting diminished physiological reserve and increased vulnerability. While the CFS provides a multidimensional, albeit partly subjective, assessment of frailty, HGS offers an objective and quantitative parameter that reinforces clinical judgment and enhances prognostic accuracy⁴\u0026sup1;.\u003c/p\u003e\u003cp\u003eThe normative values proposed by EWGSOP2 do not account for variations related to age, ethnicity, body size, lifestyle, cultural background, clinical instability, or the care setting in which handgrip strength is measured\u0026sup1;\u0026sup1;. Underestimating probable sarcopenia may lead to missed opportunities for intervention and increased risk of adverse health outcomes.\u003c/p\u003e\u003cp\u003eAccordingly, EWGSOP2 recommends the use of specific normative cut-offs when available⁴\u0026sup2;. Several studies have highlighted the need to establish modified normative values based on real-world data specific to the population under analysis. For example, a handgrip strength value of 28 kg in a young man would be considered \u0026lsquo;normal\u0026rsquo; according to EWGSOP2 and the Foundation for the National Institutes of Health Sarcopenia Project\u0026sup1;\u0026sup1;. However, when analyzing homogeneous populations (e.g., by age) and distributing values into percentiles, such a value may fall around the 5th percentile for age and sex, indicating likely sarcopenia⁶.\u003c/p\u003e\u003cp\u003eOther studies have shown that using population-specific cut-offs (e.g., 35/20 kg) compared to lower thresholds derived from British cohorts prevented underdiagnosis of probable sarcopenia in 25.3% of study participants⁴\u0026sup3;. As suggested by EWGSOP2\u0026sup2;\u0026sup2; and verified in younger populations or adjusted for ethnicity and other variables, the identification of specific normative cut-offs for frailty and sarcopenia is also necessary for patients in the emergency department.\u003c/p\u003e\u003cp\u003eOur analysis revealed a clear inverse association between handgrip strength and in-hospital mortality risk. The red curve in Fig.\u0026nbsp;1 represents the adjusted hazard ratio for hospital mortality as a function of handgrip strength, with dotted lines indicating the 95% confidence interval. The blue horizontal line corresponds to the reference value (HR\u0026thinsp;=\u0026thinsp;1). As shown, lower handgrip values are associated with an adjusted hazard ratio significantly above 1, indicating increased mortality risk. Conversely, higher grip strength values are associated with a progressive reduction in hazard ratio, approaching the reference value, suggesting a protective effect.\u003c/p\u003e\u003cp\u003eSpecifically, handgrip values below 10 kg are consistently associated with hazard ratios above the reference, indicating a higher probability of death during hospitalization. In contrast, values above 10 kg are linked to a lower risk, comparable to the average, suggesting that preserved muscle strength is a protective factor against in-hospital mortality.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWithin the emergency department setting, the formal diagnosis of probable sarcopenia may not be of primary importance. A more effective strategy may involve utilizing handgrip strength values to identify broader frailty or predict adverse outcomes. To support this approach, it is imperative to increase the availability of real-world data, thereby enabling the establishment of normative values tailored to the emergency care environment.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualization, F.F. and F.L.; methodology, R.C., S.S., F.C.; software, R.C., C.M., and C.R.; validation, M.C.; formal analysis, M.C.; investigation, S.C., A.R., C.M., and V.I.; resources, F.F. and G.D.M.; data curation, M.C.; writing\u0026mdash;original draft preparation, S.S. and C.M.; writing\u0026mdash;review and editing, S.S. and A.R.; visualization, V.I. and F.C.; supervision, A.R. and F.F.; project administration, F.F. and F.L. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u0026nbsp;\u003c/strong\u003e The study was conducted according to the principles expressed in the Declaration of Helsinki and its later amendments. It was approved by the Fondazione Policlinico Universitario A. Gemelli, IRCCS Institutional Review Board (\u0026lsquo;Differenze di et\u0026agrave; e genere nell\u0026rsquo;accesso al Pronto Soccorso\u0026rsquo; \u0026nbsp; - 0025817/22, approval date 03/08/2022 -\u0026nbsp;Clinical trial number: ID\u0026nbsp;NCT05593692).\u0026nbsp;Every patient involved in the study signed a Consent to Participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The data presented in this study are available upon reasonable requests made relative to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePallin DJ, Allen MB, Espinola JA, Camargo CA, Bohan JS. Population aging and emergency departments: visits will not increase, lengths-of-stay and hospitalizations will. Health Aff (Millwood). 2013;32(7):1306\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1377/hlthaff.2012.0951\u003c/span\u003e\u003cspan address=\"10.1377/hlthaff.2012.0951\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePreston L, van Oppen JD, Conroy SP, Ablard S, Buckley Woods H, Mason SM. Improving outcomes for older people in the emergency department: a review of reviews. Emerg Med J. 2021;38(12):882\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/emermed-2020-209514\u003c/span\u003e\u003cspan address=\"10.1136/emermed-2020-209514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŠteinmiller J, Routasalo P, Suominen T. Older people in the emergency department: a literature review. Int J Older People Nurs. 2015;10(4):284\u0026ndash;305. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/opn.12090\u003c/span\u003e\u003cspan address=\"10.1111/opn.12090\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSato R, Vatic M, Peixoto da Fonseca GW, Anker SD, von Haehling S. Biological basis and treatment of frailty and sarcopenia. Cardiovasc Res. 2024;120(9):982\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/cvr/cvae073\u003c/span\u003e\u003cspan address=\"10.1093/cvr/cvae073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLandi F, Calvani R, Tosato M, et al. Age-Related Variations of Muscle Mass, Strength, and Physical Performance in Community-Dwellers: Results From the Milan EXPO Survey. J Am Med Dir Assoc. 2017;18(1):88. .e17-88.e24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLandi F, Calvani R, Martone AM, et al. Normative values of muscle strength across ages in a real world population: results from the longevity check-up 7\u0026thinsp;+\u0026thinsp;project. J Cachexia Sarcopenia Muscle. 2020;11(6):1562\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jcsm.12610\u003c/span\u003e\u003cspan address=\"10.1002/jcsm.12610\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVermeiren S, Vella-Azzopardi R, Beckw\u0026eacute;e D, et al. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc. 2016;17(12):1163. .e1-1163.e17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClegg A, Young J. The frailty syndrome. Clin Med. 2011;11(1):72\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7861/clinmedicine.11-1-72\u003c/span\u003e\u003cspan address=\"10.7861/clinmedicine.11-1-72\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao M-C, Yen C-C, Lin Y-T, Huang F-D, Chang Y-T. Sarcopenia is associated with mortality in non-critical elderly patients visiting the emergency department. Front Med. 2022;9:1027503. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmed.2022.1027503\u003c/span\u003e\u003cspan address=\"10.3389/fmed.2022.1027503\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Lee E, Jang IY. Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci. 2020;35(3):e16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3346/jkms.2020.35.e16\u003c/span\u003e\u003cspan address=\"10.3346/jkms.2020.35.e16\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afy169\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afy169\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle. 2016;7(5):512\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jcsm.12147\u003c/span\u003e\u003cspan address=\"10.1002/jcsm.12147\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis. Gerontology. 2022;68(4):361\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000517099\u003c/span\u003e\u003cspan address=\"10.1159/000517099\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai W, Ge H, Han H, Xu J, Qin L. Association of frailty and sarcopenia with short-term mortality in older critically ill patients. J Nutr Health Aging. 2024;28(8):100321. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jnha.2024.100321\u003c/span\u003e\u003cspan address=\"10.1016/j.jnha.2024.100321\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalini S, Giovannini S, Covino M, et al. Frailty Network in an Acute Care Setting: The New Perspective for Frail Older People. Diagnostics (Basel Switzerland). 2022;12(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/diagnostics12051228\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics12051228\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eamerican college of emergency physicians. \u003cem\u003eGERIATRIC EMERGENCY DEPARTMENT GUIDELINES\u003c/em\u003e.; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePachołek K, Sobieszczańska M. Sarcopenia Identification during Comprehensive Geriatric Assessment. Int J Environ Res Public Health. 2021;19(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19010032\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19010032\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlumer J, Le B. Rethinking sarcopenia and frailty of the elderly. Post Reprod Heal. 2025;31(3):184\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/20533691251337173\u003c/span\u003e\u003cspan address=\"10.1177/20533691251337173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Shaughnessy \u0026Iacute;, Romero-Ortuno R, Edge L, et al. Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med. 2021;85:50\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejim.2020.11.015\u003c/span\u003e\u003cspan address=\"10.1016/j.ejim.2020.11.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalini S, Russo A, Calvani R, et al. Self-reported difficulty in walking 400 meters: the red flag for probable sarcopenia. BMC Geriatr. 2022;22(1):530. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-022-03231-z\u003c/span\u003e\u003cspan address=\"10.1186/s12877-022-03231-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1503/cmaj.050051\u003c/span\u003e\u003cspan address=\"10.1503/cmaj.050051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clin Interv Aging. 2019;14:1681\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/CIA.S194543\u003c/span\u003e\u003cspan address=\"10.2147/CIA.S194543\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet (London England). 2015;386(9990):266\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(14)62000-6\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(14)62000-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDodds RM, Syddall HE, Cooper R, Kuh D, Cooper C, Sayer AA. Global variation in grip strength: a systematic review and meta-analysis of normative data. Age Ageing. 2016;45(2):209\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afv192\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afv192\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChainani V, Shaharyar S, Dave K, et al. Objective measures of the frailty syndrome (hand grip strength and gait speed) and cardiovascular mortality: A systematic review. Int J Cardiol. 2016;215:487\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijcard.2016.04.068\u003c/span\u003e\u003cspan address=\"10.1016/j.ijcard.2016.04.068\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIda S, Kaneko R, Imataka K, Murata K. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol. 2019;18(1):81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12933-019-0885-2\u003c/span\u003e\u003cspan address=\"10.1186/s12933-019-0885-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0895-4356(94)90129-5\u003c/span\u003e\u003cspan address=\"10.1016/0895-4356(94)90129-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84(4):465\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.RESUSCITATION.2012.12.016\u003c/span\u003e\u003cspan address=\"10.1016/J.RESUSCITATION.2012.12.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldrich L, Ispoglou T, Prokopidis K, Alqallaf J, Wilson O, Stavropoulos-Kalinoglou A. Acute Sarcopenia: Systematic Review and Meta-Analysis on Its Incidence and Muscle Parameter Shifts During Hospitalisation. J Cachexia Sarcopenia Muscle. 2025;16(1):e13662. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jcsm.13662\u003c/span\u003e\u003cspan address=\"10.1002/jcsm.13662\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAckermans LLGC, Rabou J, Basrai M, et al. Screening, diagnosis and monitoring of sarcopenia: When to use which tool? Clin Nutr ESPEN. 2022;48:36\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clnesp.2022.01.027\u003c/span\u003e\u003cspan address=\"10.1016/j.clnesp.2022.01.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXian X, Zhang J, Yang H. A review of the status of sarcopenia in elderly hospitalized patients. Med (Baltim). 2025;104(28):e43365. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000043365\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000043365\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCovino M, Sandroni C, Della Polla D, et al. Predicting ICU admission and death in the Emergency Department: A comparison of six early warning scores. Resuscitation. 2023;190:109876. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.resuscitation.2023.109876\u003c/span\u003e\u003cspan address=\"10.1016/j.resuscitation.2023.109876\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12(4):249\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2011.01.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2011.01.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartinez BP, Batista AKMS, Gomes IB, Olivieri FM, Camelier FWR, Camelier AA. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC Musculoskelet Disord. 2015;16:108. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12891-015-0570-x\u003c/span\u003e\u003cspan address=\"10.1186/s12891-015-0570-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmoliner C, Sieber CC, Wirth R. Prevalence of sarcopenia in geriatric hospitalized patients. J Am Med Dir Assoc. 2014;15(4):267\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jamda.2013.11.027\u003c/span\u003e\u003cspan address=\"10.1016/j.jamda.2013.11.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartone AM, Bianchi L, Abete P, et al. The incidence of sarcopenia among hospitalized older patients: results from the Glisten study. J Cachexia Sarcopenia Muscle. 2017;8(6):907\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jcsm.12224\u003c/span\u003e\u003cspan address=\"10.1002/jcsm.12224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKortebein P, Symons TB, Ferrando A, et al. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol Biol Sci Med Sci. 2008;63(10):1076\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/gerona/63.10.1076\u003c/span\u003e\u003cspan address=\"10.1093/gerona/63.10.1076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLipnicki DM, Gunga H-C. Physical inactivity and cognitive functioning: results from bed rest studies. Eur J Appl Physiol. 2009;105(1):27\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00421-008-0869-5\u003c/span\u003e\u003cspan address=\"10.1007/s00421-008-0869-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu J, Xue H, Ma Y-H, Wang Z. Acute muscle loss in elderly hospitalized patients: Risk factors and adverse clinical outcomes. Geriatr Nurs. 2025;61:449\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.gerinurse.2024.12.032\u003c/span\u003e\u003cspan address=\"10.1016/j.gerinurse.2024.12.032\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLandi F, Calvani R, Cesari M, et al. Sarcopenia as the Biological Substrate of Physical Frailty. Clin Geriatr Med. 2015;31(3):367\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cger.2015.04.005\u003c/span\u003e\u003cspan address=\"10.1016/j.cger.2015.04.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaeppeli T, Rueegg M, Dreher-Hummel T, et al. Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Ann Emerg Med. 2020;76(3):291\u0026ndash;300. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.annemergmed.2020.03.028\u003c/span\u003e\u003cspan address=\"10.1016/j.annemergmed.2020.03.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(4):601. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ageing/afz046\u003c/span\u003e\u003cspan address=\"10.1093/ageing/afz046\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahat G, Kilic C, Altinkaynak M, Akif Karan M. Comparison of standard versus population-specific handgrip strength cut-off points in the detection of probable sarcopenia after launch of EWGSOP2. Aging Male. 2020;23(5):1564\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13685538.2020.1870038\u003c/span\u003e\u003cspan address=\"10.1080/13685538.2020.1870038\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7991518/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7991518/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSarcopenia and frailty are prevalent geriatric syndromes associated with adverse outcomes in older adults. Despite their clinical relevance, these conditions are rarely diagnosed or managed appropriately in emergency departments (EDs), where rapid decision-making is essential.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo investigate the prognostic value of handgrip strength (HGS) as a marker of probable sarcopenia and frailty in older adults admitted to the ED, and its association with in-hospital mortality and length of stay.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective observational study on patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years admitted to a teaching hospital ED between January and December 2024. All patients underwent Comprehensive Geriatric Assessment, including Clinical Frailty Scale (CFS) and handgrip strength testing. Probable sarcopenia was defined according to EWGSOP2 cut-offs. Primary outcomes were in-hospital mortality and length of stay. Statistical analyses included multivariate Cox regression and Kaplan\u0026ndash;Meier survival curves.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 499 patients (median age 84 years), 88.2% met criteria for probable sarcopenia. In-hospital mortality occurred in 12.4% of cases and was significantly associated with lower HGS values (Day 1: p\u0026thinsp;=\u0026thinsp;0.001; Day 3: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Day 7: p\u0026thinsp;=\u0026thinsp;0.001). Patients with lower HGS also had higher CFS scores and increased prevalence of COPD, CKD, and sepsis. A handgrip strength below 7 kg was consistently associated with an adjusted hazard ratio above 1 for mortality, indicating elevated risk.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn the ED setting, handgrip strength is a simple, objective biomarker that correlates with frailty and predicts in-hospital mortality. Rather than focusing solely on diagnosing sarcopenia, integrating HGS into routine assessment may enhance risk stratification and guide personalized care for older adults.\u003c/p\u003e","manuscriptTitle":"Handgrip Strength as a Predictor of Adverse Outcomes Among Older Adults in the Emergency Department","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 08:54:10","doi":"10.21203/rs.3.rs-7991518/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"465c2da4-4386-4bf7-8cf3-7c852e4dd3a1","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-30T11:08:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 08:54:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7991518","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7991518","identity":"rs-7991518","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}