Chong E, Bao M, Goh E F, Lim W S
Edward Chong, Department of Geriatric Medicine and Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Contact number: (65) 63596330/1, Fax number: (65) 63596294, Email:
J Nutr Health Aging. 2021;25(9):1084-1089. doi: 10.1007/s12603-021-1676-5.
Sarcopenia is associated with adverse health outcomes including mortality, functional loss, falls, and poorer quality of life. However, the value of screening sarcopenia at the Emergency Department (ED) remains unclear. We aimed to examine the SARC-F questionnaire for its (1) diagnostic ability in identifying frailty, and (2) predictive ability for adverse health outcomes.
A secondary analysis of a quasi-experimental study.
An ED within a 1700-bed tertiary hospital.
ED patients aged ≥85 years (mean age 90.0 years) recruited into the Emergency Department Interventions of Frailty (EDIFY) study.
Data of demographics, premorbid function, frailty status [Frailty Index (FI), Clinical Frailty Scale (CFS), FRAIL], comorbidities, medications, and cognitive status were gathered. We also captured outcomes of mortality, acute hospitalization, and ED reattendance at 1-, 3-, and 6-month. We then compared area under the operating characteristic curves (AUCs) for the abovementioned measures against the FI (reference) for diagnosis of frailty. Lastly, we performed univariate analyses and logistic regression to compare SARC-F and other measures against the adverse outcomes of interest.
Amongst the various instruments, the SARC-F (AUC 0.92, 95% Confidence Interval (CI) 0.86-0.98, P<0.001; Sensitivity 79.0%, and Specificity 88.9%) performed best for frailty detection as defined by FI. Optimal cutoff was ≥3 (Sensitivity 91.4%, Specificity 83.3%, and Negative Predictive Value 68.2%). Only SARC-F was predictive of acute hospitalization [Adjusted Odds Ratio (OR) 4.00, 95% CI 1.47-10.94, P=0.007] and ED-reattendance [Adjusted OR 3.29, 95% CI 1.26-8.56, P=0.015] at 3-month.
The SARC-F demonstrated excellent diagnostic ability for frailty detection and predictive validity for ED reattendance and acute hospitalization at 3 months. Lowering cutoff score to ≥3 may improve case-finding at the ED to facilitate early identification and management of sarcopenia. Further studies are required to validate the diagnostic and predictive performance of SARC-F at ED settings.
肌肉减少症与包括死亡率、功能丧失、跌倒及较差生活质量在内的不良健康结局相关。然而，在急诊科（ED）筛查肌肉减少症的价值仍不明确。我们旨在研究SARC-F问卷的（1）识别衰弱的诊断能力，以及（2）对不良健康结局的预测能力。
一项准实验研究的二次分析。
一家拥有1700张床位的三级医院内的急诊科。
纳入急诊科衰弱干预（EDIFY）研究的85岁及以上（平均年龄90.0岁）的急诊科患者。
收集人口统计学、病前功能、衰弱状态[衰弱指数（FI）、临床衰弱量表（CFS）、FRAIL]、合并症、用药情况及认知状态的数据。我们还记录了1个月、3个月和6个月时的死亡率、急性住院情况及再次到急诊科就诊的情况。然后，我们将上述测量指标的操作特征曲线下面积（AUC）与用于诊断衰弱的FI（参考指标）进行比较。最后，我们进行单因素分析和逻辑回归，以比较SARC-F和其他指标与感兴趣的不良结局。
在各种工具中，SARC-F（AUC为0.92，95%置信区间（CI）为0.86 - 0.98，P<0.001；灵敏度为79.0%，特异性为88.9%）在检测由FI定义的衰弱方面表现最佳。最佳截断值为≥3（灵敏度为91.4%，特异性为83.3%，阴性预测值为68.2%）。只有SARC-F能预测3个月时的急性住院情况[调整优势比（OR）为4.00，95%CI为1.47 - 10.94，P = 0.007]和再次到急诊科就诊情况[调整OR为3.29，95%CI为1.26 - 8.56，P = 0.015]。
SARC-F在检测衰弱方面显示出出色的诊断能力，对3个月时再次到急诊科就诊和急性住院具有预测效度。将截断分数降低至≥3可能会改善急诊科的病例发现情况，以促进肌肉减少症的早期识别和管理。需要进一步研究以验证SARC-F在急诊科环境中的诊断和预测性能。
