Department of Nutrition and Dietetics, School of Medicine, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
J Cachexia Sarcopenia Muscle. 2013 Sep;4(3):209-16. doi: 10.1007/s13539-013-0108-8. Epub 2013 May 18.
Geriatric cachexia is distinct from other age-related muscle wasting syndromes; however, detection and therefore treatment is challenging without the availability of valid instruments suitable for application in the clinical setting. This study assessed the sensitivity and specificity of a newly developed screening instrument utilising portable assessments against previously defined and commonly accepted diagnostic criteria for detection of geriatric cachexia.
Cross-sectional analyses from 71 older adults' post-surgical fixation for hip fracture were performed. The diagnostic criteria required measures of appendicular skeletal muscle index derived from dual-energy X-ray absorptiometry and anorexia assessed by ≤70 % of estimated energy requirements. These assessments were replaced with mid-upper arm muscle circumference and the Simplified Nutritional Appetite Questionnaire, respectively, to create a field instrument suitable for screening geriatric cachexia. Sensitivity, specificity and positive and negative predictive values were calculated.
The current diagnostic algorithm identified few patients as cachectic (4/71; 5.6 %). The sensitivity and specificity of the geriatric cachexia screening tool was 75 and 97 %, respectively. The screening tool had a positive predictive value of 60 % and a negative predictive value of 99 %.
Given the unexpected prevalence of cachexia in such a vulnerable group, these results may suggest problems in operationalising of the consensus definition and diagnostic criteria. Although the application of a newly developed screening tool using portable field measures looks promising, the authors recommend additional research to identify the prevalence of geriatric cachexia, which captures all diagnostic criteria from the consensus definition. Future investigation may then be positioned to explore the predictive validity of screening tools using portable field measures, which potentially achieve higher sensitivity.
老年消耗症与其他与年龄相关的肌肉消耗综合征不同；然而，如果没有适合临床应用的有效仪器，就很难发现，因此也难以治疗。本研究评估了一种新开发的筛查工具的敏感性和特异性，该工具利用便携式评估方法，针对以前定义的和普遍接受的用于检测老年消耗症的诊断标准。
对 71 名髋部骨折手术后的老年人进行了横断面分析。诊断标准需要使用双能 X 射线吸收仪测量四肢骨骼肌指数，并通过 ≤70%的估计能量需求来评估厌食症。这些评估分别被中上臂肌肉围度和简化营养食欲问卷所取代，以创建一种适合筛查老年消耗症的现场仪器。计算了敏感性、特异性以及阳性和阴性预测值。
目前的诊断算法将很少的患者识别为消耗症（4/71；5.6%）。老年消耗症筛查工具的敏感性和特异性分别为 75%和 97%。该筛查工具的阳性预测值为 60%，阴性预测值为 99%。
鉴于如此脆弱的群体中消耗症的发生率出乎意料，这些结果可能表明共识定义和诊断标准的操作性存在问题。虽然使用便携式现场测量方法开发的新筛查工具的应用看起来很有前景，但作者建议进行更多的研究来确定符合共识定义的老年消耗症的患病率。未来的研究可能会探索使用便携式现场测量方法进行筛查工具的预测有效性，这可能会提高敏感性。
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