Practical screening tools for sarcopenia in patients with systemic sclerosis

Abstract

Introduction In view of the method of diagnosing sarcopenia being complex and considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends the use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice. Only recently, some studies have turned their attention to the presence of sarcopenia in systemic sclerosis (SSc).There is no data about performance of SARC-F and other screening tests for sarcopenia in this population. Objective To compare the accuracy of SARC-F, SARC-CalF, SARC-F+EBM, and Ishii test as screening tools for sarcopenia in patients with SSc. Methods Cross-sectional study of 94 patients with SSc assessed by clinical and physical evaluation. Sarcopenia was defined according to the revised 2019 EWGSOP diagnostic criteria (EWGSOP2) with assessments of dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB). As case finding tools, SARC-F, SARC-CalF, SARC-F+EBM and Ishii test were applied, including data on calf circumference, body mass index, limitations in strength, walking ability, rising from a chair, stair climbing, and self reported number of falls in the last year. The screening tests were evaluated through receiver operating characteristic (ROC) curves. Standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia. Results Sarcopenia was identified in 15 (15.9%) patients with SSc by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.420–0.756, p = 0.283). The results of sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic Odds Ratio (DOR) with the EWGSOP2 criteria as the gold standard were 40.0% (95% CI, 19.8–64.2), 81.0% (95% CI, 71.0–88.1), 2.11 (95% CI, 0.98–4.55), 0.74 (95% CI, 0.48–1.13) and 2.84 (95% CI, 0.88–9.22), respectively. SARC-CalF and SARC-F+EBM showed better sensitivity (53.3%, 95% CI 30.1–75.2 and 60.0%, 95% CI 35.7–80.2, respectively) and specificity (84.8%, 95% CI 75.3–91.1 and 86.1%, 95% CI 76.8–92.0, respectively) compared with SARC-F. The best sensitivity was obtained with the Ishii test (86.7%, 95% CI 62.1–96.3), at the expense of a small loss of specificity (73.4%, 95% CI 62.7–81.9). Comparing the ROC curves, SARC-F performed worse than SARC-CalF, SARC-F+EBM and Ishii test as a sarcopenia screening tool in this population (AUCs 0.588 vs. 0.718, 0.832, and 0.862, respectively). Direct comparisons between tests revealed differences only between SARC-F and Ishii test for sensitivity (p = 0.013) and AUC (p = 0.031). Conclusion SARC-CalF, SARC-F+EBM, and Ishii test performed better than SARC-F alone as screening tools for sarcopenia in patients with SSc. Considering diagnostic accuracy and feasibility aspects, SARC-F+EBM seems to be the most suitable screening tool to be adopted in routine care of patients with SSc.

Screening Tools for Sarcopenia

“…In a study of 717 patients with chronic liver diseases (CLDs), the sensitivity and specificity of SARC-F for sarcopenia assessed by the JSH were 0.65 and 0.68 when the cutoff value of SARC-F was set at 1, and the predictive ability was better than when the cutoff value of SARC-F was set at 4 (49). In a study of 94 patients with systemic sclerosis, the sensitivity and specificity for sarcopenia assessed by EWGSOP2 were 0.400 and 0.810 for the SARC-F, and 0.533 and 0.848 for the SARCcalf, respectively (50). In a study of 355 patients with chronic heart failure, the sensitivity and specificity of SARC-F for sarcopenia assessed by AWGS were 0.525 and 0.962, respectively, and in terms of predictive ability on Mini Sarcopenia Risk Assessment (MSRA, described later) for sarcopenia, the MSRA-7 had a sensitivity of 0.924 and a specificity of 0.516, and the MSRA-5 had a sensitivity of 0.939 and a specificity of 0.573.…”

“…Ishii screening tool has been reported to have high sensitivity and specificity (0.849 and 0.882 for men, 0.755 and 0.920 for women) for the diagnosis of sarcopenia in the elderly (66). In a study of 94 patients with systemic sclerosis, the sensitivity, specificity, and AUC of the Ishii screening tool for sarcopenia were 0.867, 0.734, and 0.862, respectively (50).…”

The frequency of sarcopenia and factors affecting appendicular muscle mass in patients with systemic sclerosis

“…Лишь в 2 работах зарубежных авторов оценивалась частота СП: в одной из них мышечная масса была измерена с помощью биоимпедансного анализа, в другой -DXA. В 1-м случае частота СП составила 22,5 % О р и г и н а л ь н о е и с с л е д о в а н и е | O r i g i n a l i n v e s t i g a t i o n [8], а во втором -15,9 % [12]. Более низкая частота СП в исследовании V. Hax и соавт.…”

Prediction of Physical Frailty in Orthogeriatric Patients Using Sensor Insole–Based Gait Analysis and Machine Learning Algorithms: Cross-sectional Study

“…All data were collected in a standardized fashion by a unique, specially trained investigator. Demographic data included age, weight, height, BMI, body composition, general health-related quality of life assessed by the European Quality of Life 5-dimension (EQ-5D-5L) questionnaire [ 19 ], and the sarcopenia and physical frailty screening questionnaire SARC-F [ 20 ]. All questionnaires were completed together with the patients to obtain the highest possible data quality.…”