Easy surveillance of muscle volume decline in chronic liver disease patients using finger‐circle (yubi‐wakka) test

Abstract

Background Muscle atrophy (MA) and muscle strength decline are important clinical features in chronic liver disease (CLD) patients. An easy to perform MA screening method without need for special equipment would be helpful. We evaluated the usefulness of the previously reported finger‐circle test as screening for MA in CLD patients. Methods We retrospectively enrolled 358 Japanese CLD outpatients (70.8 ± 10.2 years, male/female = 234/124) who had undergone a computed tomography examination from December 2017 to March 2018, of whom 137 had chronic hepatitis, 169 had liver cirrhosis Child–Pugh A, and 52 had liver cirrhosis Child–Pugh B/C. Bilateral psoas muscle area at the middle of the third lumber vertebra (L3) was evaluated with computed tomography findings, which was performed as a screening of hepatocellular carcinoma, using a previously reported parameter for MA [psoas index (PI): total psoas muscle area (cm 2 )/height (m) 2 ] [mean PI ± standard deviation (SD) of male patients: 6.50 ± 1.13 cm 2 /m 2 and those of female patients: 4.30 ± 0.90 cm 2 /m 2 ]. We then evaluated the correlation between MA and finger‐circle test results in these patients. Results The mean PI values for finger‐circle test results Bigger, Just‐fits, and Smaller were 5.64 ± 1.34, 5.00 ± 1.25, and 4.83 ± 1.46 cm 2 /m 2 , respectively, in male patients ( P < 0.001) and 4.31 ± 1.06, 3.93 ± 0.97, and 3.42 ± 0.94 cm 2 /m 2 , respectively, in female patients ( P = 0.001). We found that a finger‐circle test result in male patients other than Bigger (Just‐fits and Smaller) predicted a decline in psoas muscle area of L3 to PI 5.25 cm 2 /m 2 (sensitivity/specificity 0.619/0.667, area under the curve 0.654, 95% confidence interval 0.583–0.724), which was approximately mean minus 1 SD (5.37 cm 2 /m 2 ). On the other hand, a Smaller test result in female patients predicted a decline in psoas muscle area of L3 to PI 3.33 cm 2 /m 2 (sensitivity/specificity 0.740/0.583, area under the curve 0.698, 95% confidence interval 0.583–0.813), approximately mean minus 1 SD (3.40 cm 2 /m 2 ). Conclusions The finger‐circle test is an easy to perform and effective screening method for predicting earlier stage of MA in CLD patients without the need for special equipment.

SARC‐F combined with a simple tool for assessment of muscle abnormalities in outpatients with chronic liver disease

“…CC testing was reported to be easy to perform and useful for muscle volume abnormality (cut‐off values: men 34 cm; women 33 cm) . Furthermore, the finger‐circle ( yubi‐wakka ) test, in which the fingers of the patient are used for assessment, has been proposed, after which its usefulness for screening of pre‐MVL in CLD patients was shown (sensitivity/specificity/AUC: 0.619/0.667/0.654 in men, 0.740/0.583/0.698 in women) . The EWGSOP recently upgraded their surveillance strategy for sarcopenia, termed EWGSOP‐2, in which SARC‐F was added as a first‐step questionnaire …”

“…In the present study, a mean PI value lower than −1 SD was defined as pre‐MVL (men 5.37 cm 2 /m 2 , women 3.4 cm 2 /m 2 ). Pre‐MVL was set as an abnormal line of muscle volume to investigate with SARC‐F, because the finger‐circle test, which has a predictive value for pre‐MVL in CLD, was used as one of the muscle volume assessment tools in the present study …”

“…Based on the results of the finger‐circle test, the present patients were divided into three groups: bigger, just‐fits, and smaller. The results of previous reports (prediction for pre‐MVL: men just‐fits, women smaller) were used to determine the presence of muscle volume abnormality in the present study …”

“…For assessment of muscle volume, computed tomography (CT), dual‐energy X‐ray absorptiometry, and bioelectrical impedance analysis (BIA) are recommended modalities, although those are difficult for general practice physicians to perform for surveillance of their CLD patients. In an evaluation of muscle volume without use of special equipment, Kawakami reported the usefulness of calf circumference (CC) for assessment of muscle volume loss (cut‐off values indicating abnormality: men 34 cm, women 33 cm), while a yubi‐wakka (finger‐circle) test has also been developed to determine whether the maximum non‐dominant calf circumference is larger than finger‐circle circumference, formed with the index finger and thumbs of both hands, in affected patients …”

Analysis of the optimal psoas muscle mass index cut‐off values, as measured by computed tomography, for the diagnosis of loss of skeletal muscle mass in Japanese people

“…The PMI is calculated as follows: the sum of the L3 level cross‐sectional area of the right and left psoas muscle mass as identified by manual tracing on CT imaging is divided by the height squared (cm 2 /m 2 ) 14 . With regard to liver disease, various reports have already evaluated skeletal muscle mass using PMI 9,14–18 . Thus, PMI is one of the established methods for evaluating skeletal muscle mass.…”