Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India.
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160 012, India.
Indian J Gastroenterol. 2022 Jun;41(3):284-291. doi: 10.1007/s12664-022-01255-2. Epub 2022 Jul 19.
Skeletal muscle index (SMI), the gold standard for sarcopenia, cannot measure muscle strength and requires specialized software and training. Hand-grip strength (HGS) measurement is cheap, requires minimal training and directly reflects muscle strength. We assessed the performance of HGS as a screening tool for sarcopenia in male patients with decompensated cirrhosis (DC).
Consecutive male DC patients (n=155) were enrolled. Baseline liver functions, etiologic work-up and anthropometric measurements were done. SMI was determined from computed tomography (CT) images at L3 level using ImageJ software. Sarcopenia was diagnosed using SMI cut-off <42 cm/m as suggested by the Indian National Association for Study of the Liver. HGS was assessed using a hand-grip dynamometer. Diagnostic performance of HGS for discriminating sarcopenia was described using receiver operating characteristic (ROC) analysis. Diagnostic performance of different HGS cut-offs was assessed. Findings were internally validated using bootstrapping.
Mean HGS and SMI were 25.73 ± 5.94 kg and 47.72 ± 8.71 cm/m, respectively. HGS showed modest correlation with SMI (tau: 0.31, p <0.001). Sarcopenia was seen in 41 (26.5%) patients. Age and HGS were independent predictors of sarcopenia on multivariate analysis. Area under the ROC curve (AUROC) of HGS for detecting sarcopenia was 0.73 (p<0.001). Optimal cut-off for using HGS as a screening tool was ≤31 kg (sensitivity: 37/41 [90.2%]; specificity: 29/114 [25.4%]; positive predictive value [PPV] : 37/122 [30.3%]; and negative predictive value [NPV]: 29/33 [87.9%]).
Prevalence of sarcopenia in Indian male patients with DC is 26.5%. HGS is an independent predictor of sarcopenia and can be used as a screening tool to stratify the need for confirmatory CT-based assessment of sarcopenia.
骨骼肌指数（SMI）是肌少症的金标准，但无法衡量肌肉力量，且需要专门的软件和培训。手握力（HGS）测量价格便宜，所需培训最少，且直接反映肌肉力量。我们评估了 HGS 作为男性失代偿期肝硬化（DC）患者肌少症筛查工具的性能。
连续纳入男性 DC 患者（n=155）。进行基线肝功能、病因学检查和人体测量学测量。使用 ImageJ 软件从 L3 水平的 CT 图像确定 SMI。根据印度国家肝病研究协会建议的 SMI 截断值＜42 cm/m 诊断肌少症。使用握力计评估 HGS。使用受试者工作特征（ROC）分析描述 HGS 区分肌少症的诊断性能。评估了不同 HGS 截断值的诊断性能。使用自举法对内部分验证结果。
平均 HGS 和 SMI 分别为 25.73 ± 5.94 kg 和 47.72 ± 8.71 cm/m。HGS 与 SMI 呈中度相关（tau：0.31，p＜0.001）。41 例（26.5%）患者存在肌少症。年龄和 HGS 是多变量分析中肌少症的独立预测因素。HGS 检测肌少症的 ROC 曲线下面积（AUROC）为 0.73（p＜0.001）。使用 HGS 作为筛查工具的最佳截断值为≤31 kg（灵敏度：41/41 [90.2%]；特异性：114/29 [25.4%]；阳性预测值[PPV]：122/41 [30.3%]；阴性预测值[NPV]：33/29 [87.9%]）。
印度男性 DC 患者肌少症的患病率为 26.5%。HGS 是肌少症的独立预测因素，可作为一种筛查工具，用于分层确定是否需要进行基于 CT 的肌少症确认性评估。
