Nakade Taisuke, Maeda Daichi, Matsue Yuya, Kagiyama Nobuyuki, Fujimoto Yudai, Sunayama Tsutomu, Dotare Taishi, Jujo Kentaro, Saito Kazuya, Kamiya Kentaro, Saito Hiroshi, Ogasahara Yuki, Maekawa Emi, Konishi Masaaki, Kitai Takeshi, Iwata Kentaro, Wada Hiroshi, Kasai Takatoshi, Nagamatsu Hirofumi, Momomura Shin-Ichi, Minamino Tohru
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
J Am Med Dir Assoc. 2025 Jan;26(1):105350. doi: 10.1016/j.jamda.2024.105350. Epub 2024 Nov 12.
The Asian Working Group for Sarcopenia in 2019 (AWGS 2019) emphasized muscle mass measurements. In contrast, the Sarcopenia Definitions and Outcomes Consortium (SDOC) prioritizes functional strength and mobility. Therefore, this study aimed to compare the prognostic utility of the SDOC and AWGS 2019 criteria for all-cause mortality in older patients with heart failure.
A post hoc analysis of the Prevalence and Prognostic Value of Physical and Social Frailty in Geriatric Patients Hospitalized for Heart Failure (FRAGILE-HF) study, a prospective, multicenter, observational study.
Patients aged ≥65 years hospitalized for heart failure across 15 hospitals in Japan.
Sarcopenia was diagnosed according to the AWGS 2019 and SDOC definitions. According to the SDOC criteria and by integrating insights from previous research, patients were categorized into nonsarcopenia, possible sarcopenia, and sarcopenia groups. The primary outcome was 2-year mortality.
Of the 1282 study patients, possible sarcopenia and sarcopenia were diagnosed in 357 and 786 individuals, respectively. Kaplan-Meier analysis revealed a significant difference between the groups. Adjusted Cox proportional hazards analysis indicated a significant stepwise association between sarcopenic status and mortality risk (possible sarcopenia: hazard ratio, 1.22; 95% CI, 0.66-2.28; P = .525; sarcopenia: hazard ratio, 1.89; 95% CI, 1.08-3.34; P = .027). When sarcopenia defined by the SDOC and AWGS 2019 criteria was added to the model incorporating conventional risk factors, no significant difference was observed in the prognostic capabilities between the 2 models (net reclassification improvement, -0.009; 95% CI, -0.193 to 0.174; P = .920, with areas under the receiver operating characteristic curve of 0.697 for SDOC and 0.703 for AWGS 2019; P = .675).
Among older patients with heart failure, the SDOC criteria for sarcopenia diagnosis are useful for risk stratification and provide prognostic capabilities equivalent to those of the AWGS 2019 criteria.
2019年亚洲肌少症工作组（AWGS 2019）强调肌肉量测量。相比之下，肌少症定义与结局联盟（SDOC）则将功能强度和活动能力作为优先考量。因此，本研究旨在比较SDOC和AWGS 2019标准对老年心力衰竭患者全因死亡率的预后效用。
对心力衰竭住院老年患者身体与社会衰弱的患病率及预后价值（FRAGILE-HF）研究进行事后分析，这是一项前瞻性、多中心观察性研究。
日本15家医院中因心力衰竭住院的年龄≥65岁的患者。
根据AWGS 2019和SDOC定义诊断肌少症。根据SDOC标准并结合既往研究的见解，将患者分为非肌少症、可能肌少症和肌少症组。主要结局为2年死亡率。
在1282例研究患者中，分别有357例和786例被诊断为可能肌少症和肌少症。Kaplan-Meier分析显示各组之间存在显著差异。校正后的Cox比例风险分析表明，肌少症状态与死亡风险之间存在显著的逐步关联（可能肌少症：风险比，1.22；95%置信区间，0.66 - 2.28；P = 0.525；肌少症：风险比，1.89；95%置信区间，1.08 - 3.34；P = 0.027）。当将SDOC和AWGS 2019标准定义的肌少症添加到包含传统风险因素的模型中时，两个模型在预后能力方面未观察到显著差异（净重新分类改善，-0.009；95%置信区间，-0.193至0.174；P = 0.920，SDOC的受试者工作特征曲线下面积为0.697，AWGS 2019为0.703；P = 0.675）。
在老年心力衰竭患者中，SDOC的肌少症诊断标准对风险分层有用，且提供了与AWGS 2019标准相当的预后能力。
