Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, Istanbul 34093, Türkiye.
Department of Public Health, Istanbul Medical School, Istanbul University, Capa, Istanbul 34093, Türkiye.
J Geriatr Oncol. 2023 Nov;14(8):101630. doi: 10.1016/j.jgo.2023.101630. Epub 2023 Sep 22.
Sarcopenia is a prevalent disorder in older adults with significant adverse outcomes and regular screening is recommended for those at risk. The SARC-F questionnaire is the most commonly recommended screening tool for sarcopenia. However, as a self-reported tool, it cannot be applied to dependent individuals with communication problems. We hypothesized that implementation of the proxy-reported SARC-F (SARC-F by proxy) would be non-inferior in screening sarcopenia when compared with the standard SARC-F. Thus, we aimed to investigate the clinical validity of the SARC-F by proxy in identifying sarcopenia in older adults and to compare its performance with the standard SARC-F. Additionally, we aimed to determine the ideal cut-off of SARC-F by proxy in screening sarcopenia.
This is a validation study including older adults aged ≥60 years without communication problems and their close proxies. The participants were recruited from a geriatric outpatient clinic of a tertiary health center and a nursing home. Standard SARC-F was transformed to SARC-F by proxy and administered to the proxies of older adults, and standard SARC-F was administered to the patients simultaneously in different rooms. We defined sarcopenia as probable and confirmed by the EWGSOP2 consensus report. We performed receiver operating characteristics (ROC) and sensitivity/specificity analyses of SARC-F by proxy for diagnosing sarcopenia and compared its performance with standard SARC-F by the DeLong test.
We included 172 older adults (median age: 72; 44.8% female) and 107 proxies in close contact (median age: 55, 63.2% female). The prevalence of probable and confirmed sarcopenia was 18.9% and 12.9%, respectively. For both definitions, area under the curve (AUC) values of SARC-F by proxy and standard SARC-F were moderate and similar [probable sarcopenia: 0.619 and 0.624 (p = 0.9); confirmed sarcopenia 0.613 and 0.645 (p = 0.7), respectively]. The best balance between sensitivity and specificity was achieved with a SARC-F by proxy score of ≥2 for both sarcopenia definitions (sensitivity levels were 74.7% and 77.8%, and specificity levels were 50.0% and 49.6%, for probable and confirmed sarcopenia, respectively).
SARC-F by proxy showed a similar, non-inferior performance compared to the standard SARC-F in the evaluation of sarcopenia. Our results suggest that it can be used instead of standard SARC-F to screen sarcopenia in older patients with communication problems. Further validation studies in different populations are warranted to support our findings.
肌少症是老年人中普遍存在的疾病，会产生严重的不良后果，建议对高危人群进行常规筛查。SARC-F 问卷是最常被推荐用于肌少症筛查的工具。然而，作为一种自我报告的工具，它不能用于有沟通问题的依赖个体。我们假设代理报告的 SARC-F（SARC-F by proxy）在筛查肌少症方面与标准 SARC-F 相比具有非劣效性。因此，我们旨在研究代理报告的 SARC-F（SARC-F by proxy）在识别老年人肌少症方面的临床有效性，并比较其与标准 SARC-F 的性能。此外，我们旨在确定 SARC-F by proxy 筛查肌少症的理想截断值。
这是一项验证性研究，纳入了年龄≥60 岁、无沟通问题且有密切亲属的老年人及其亲属。参与者来自一家三级保健中心的老年门诊和一家疗养院。对老年人的亲属进行标准 SARC-F 转化为 SARC-F by proxy，并同时在不同房间对患者进行标准 SARC-F 测试。我们根据 EWGSOP2 共识报告将肌少症定义为可能和确诊。我们对 SARC-F by proxy 进行了诊断肌少症的受试者工作特征（ROC）和敏感性/特异性分析，并通过 DeLong 检验比较了其与标准 SARC-F 的性能。
我们纳入了 172 名老年人（中位年龄：72 岁，44.8%为女性）和 107 名密切接触的亲属（中位年龄：55 岁，63.2%为女性）。可能和确诊的肌少症患病率分别为 18.9%和 12.9%。对于这两种定义，SARC-F by proxy 和标准 SARC-F 的曲线下面积（AUC）值均为中等且相似[可能的肌少症：0.619 和 0.624（p=0.9）；确诊的肌少症：0.613 和 0.645（p=0.7）]。对于这两种肌少症定义，SARC-F by proxy 评分≥2 时均能达到最佳的敏感性和特异性平衡（敏感性水平分别为 74.7%和 77.8%，特异性水平分别为 50.0%和 49.6%）。
SARC-F by proxy 在评估肌少症方面与标准 SARC-F 具有相似的、非劣效的性能。我们的研究结果表明，在有沟通问题的老年患者中，它可以替代标准 SARC-F 进行肌少症筛查。需要在不同人群中进行进一步的验证研究来支持我们的发现。
