Utility of the SARC-F Questionnaire for Sarcopenia Screening in Patients with Chronic Liver Disease: A Multicenter Cross-Sectional Study in Japan

Abstract

Diagnosing sarcopenia is challenging. This multicenter cross-sectional study aimed to evaluate the utility of the SARC-F score system for identifying sarcopenia in patients with chronic liver disease (CLD). We enrolled 717 patients from five participating centers who completed the SARC-F between November 2019 and March 2021. Sarcopenia was diagnosed based on the Japan Society of Hepatology Working Group on Sarcopenia in Liver Disease Consensus. Muscle strength was estimated using a grip dynamometer, and muscle mass was assessed using computed tomography or bioelectrical impedance analysis. The association between SARC-F and sarcopenia was analyzed using a logistic regression model. The optimal SARC-F cutoff value for identifying sarcopenia was determined using receiver operating characteristic (ROC) curve analysis. Of the 676 eligible patients, 15% were diagnosed with sarcopenia. The SARC-F distribution was 0 points in 63% of patients, 1 point in 17%, 2 points in 7%, 3 points in 4%, and ≥4 points in 8%. The SARC-F items of “Strength” (odds ratio (OR), 1.98; 95% confidence interval (CI), 1.03–3.80) and “Falls” (OR, 2.44; 95% CI, 1.48–4.03) were significantly associated with sarcopenia. The SARC-F value of 1 point showed a higher discriminative ability for identifying sarcopenia than the 4 points that are conventionally used (p < 0.001), with an area under the ROC curve of 0.68, sensitivity of 0.65, specificity of 0.68, positive predictive value of 0.27, and negative predictive value of 0.92. SARC-F is useful for identifying patients with CLD who are at risk of sarcopenia.

Prognostic Impact of the SARC-F Score in Gastrointestinal Advanced Cancers

“…As described above, a relatively lower sensitivity of the SARC-F score for sarcopenia may be a problem, which is identical to our data [ 21 , 22 , 23 ]. Hanai et al reported in their large cohort with chronic liver disease that a SARC-F score = 1 demonstrated a stronger discrimination capability for selecting sarcopenia than a SARC-F score = 4, with an AUC of 0.68, and with the sensitivity/specificity of 0.65/0.68 [ 36 ]. In view of these, the cutoff point of the SARC-F score should be carefully reviewed.…”

Screening Tools for Sarcopenia

“…In a study of 127 patients undergoing peritoneal dialysis, the sensitivity and specificity of SARC-F for sarcopenia assessed by AWGS2 were 0.700 and 0.812, respectively (48). 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).…”

Insulin‐like growth factor 1 and dehydroepiandrosterone levels in alcoholic liver cirrhosis

“…All individuals with SARC‐values ≥4 were counted as sarcopenic. 5 , 6 Additionally, all individuals underwent a handgrip strength test. Here, values ≤18 kg for women or 25.5 kg for men were counted as sarcopenic.…”

“…Sarcopenia was assessed in all patients and controls using the SARC‐F questionnaire (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls). All individuals with SARC‐values ≥4 were counted as sarcopenic 5,6 . Additionally, all individuals underwent a handgrip strength test.…”