Department of Rehabilitation, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Medicine, Austin Health, Melbourne Medical School, The University of Melbourne, Heidelberg, Victoria, Australia.
Department of Medicine, Austin Health, Melbourne Medical School, The University of Melbourne, Heidelberg, Victoria, Australia; Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, The Univesity of Melbourne, Parkville, Victoria, Australia.
Clin Nutr. 2021 Mar;40(3):1022-1027. doi: 10.1016/j.clnu.2020.06.034. Epub 2020 Jul 14.
BACKGROUND & AIMS: Sarcopenia is prevalent in post acute inpatient rehabilitation. An easy to administer screening test may improve identification of sarcopenia in this population, which may promote its early detection and treatment. THE AIMS OF THIS STUDY WERE: a) To investigate clinical utility of SARC-F as a European Working Group on Sarcopenia in Older People2 (EWGSOP2) recommended tool for sarcopenia case finding in post acute inpatient rehabilitation. b) To develop an easy and pragmatic screening test for sarcopenia in healthcare settings with limited ability to measure the patients' muscle mass for confirmation of the sarcopenia diagnosis.
This cross-sectional study with prospective data collection recruited patients admitted to a general inpatient rehabilitation unit in a metropolitan tertiary referral hospital in Australia. Participant's true sarcopenia status was ascertained, as per EWGSOP2, from their grip strength and muscle mass. Two SARC-F questionnaires were administered, for participants' current and, by recall, premorbid status. To develop GripBMI screening tool, BMI test positivity cut off was established on training sample and validated in conjunction with the established grip strength cut off on validation sample using area under the Receiver Operating Curve (ROC) analysis.
True prevalence of sarcopenia in 277 participants (median age 64 years (IQR 53-72), 52% male) was 14% (95%CI 11%-19%). Screening utility of SARC-F positive status at the time of admission for sarcopenia had ROC of 0.50, and of premorbid SARC-F positive status had ROC of 0.51. Out of 42 participants positive on the GripBMI screen, 33 had sarcopenia, and out of 235 participants negative on the GripBMI screen, 7 participants had sarcopenia, resulting in GripBMI ROC area 0.89, sensitivity 83%, specificity 96%, positive predictive value 79%, negative predictive value 97%, diagnostic odds ratio 119 (95% CI 42-338).
The GripBMI screening tool uses the combination of EWGSOP2 recommended low grip strength cut offs and Body Mass Index of less than 25 as a positive screening test for sarcopenia. It may assist in promoting early detection and management of sarcopenia in post acute inpatient rehabilitation.
肌少症在急性后期住院康复患者中较为常见。一种易于管理的筛查测试可能会提高该人群中肌少症的识别率，从而促进其早期发现和治疗。本研究的目的是：a）研究 SARC-F 作为欧洲老年人肌少症工作组 2（EWGSOP2）推荐的肌少症筛查工具，用于急性后期住院康复患者的肌少症病例发现的临床实用性。b）开发一种简单实用的筛查工具，用于医疗保健环境中，这些环境对患者的肌肉质量进行测量以确认肌少症诊断的能力有限。
这项前瞻性数据收集的横断面研究招募了澳大利亚一家大都市三级转诊医院普通住院康复病房的患者。根据 EWGSOP2，通过握力和肌肉质量来确定参与者的真实肌少症状态。对参与者目前的和通过回忆获得的患病前的状态进行了两次 SARC-F 问卷调查。为了开发 GripBMI 筛查工具，在训练样本中建立 BMI 测试阳性截断值，并结合验证样本中已建立的握力截断值，使用接受者操作特征曲线（ROC）分析进行验证。
在 277 名参与者（中位数年龄 64 岁（IQR 53-72），52%为男性）中，真实肌少症的患病率为 14%（95%CI 11%-19%）。入院时 SARC-F 阳性状态的筛查效用的 ROC 为 0.50，患病前 SARC-F 阳性状态的 ROC 为 0.51。在 42 名 GripBMI 筛查阳性的参与者中，有 33 名患有肌少症，在 235 名 GripBMI 筛查阴性的参与者中，有 7 名患有肌少症，GripBMI 的 ROC 面积为 0.89，灵敏度为 83%，特异性为 96%，阳性预测值为 79%，阴性预测值为 97%，诊断比值比为 119（95%CI 42-338）。
GripBMI 筛查工具使用 EWGSOP2 推荐的低握力截断值和 BMI<25 作为肌少症的阳性筛查测试。它可能有助于促进急性后期住院康复患者肌少症的早期发现和管理。
