Evaluation of the Accuracy of Six Simple Screening Tools for Sarcopenia in Schizophrenic Patients

Comparative analysis of SARC-F-EBM, Ishii test, and six other screening tools for sarcopenia in Chinese community-dwelling older adults: a cross-sectional diagnostic study

To assess the relative performance of simple screening methods for sarcopenia in Chinese community-dwelling older adults. Data of older adults aged ≥ 60 were collected through a cross-sectional investigation. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The accuracy of screening methods was evaluated using sensitivity, specificity, receiver operating characteristic (ROC) curves and area under the ROC curves (AUC). The AUC value greater than 0.8 represented the good screening ability. A total of 918 older adults (44.3% men, mean age 70.4 ± 6.5 years) were included in this study. The overall prevalence rates of possible sarcopenia, confirmed sarcopenia, and severe sarcopenia were 59.5%, 12.8%, and 5.9%, respectively. In men, the SARC-F-EBM and Ishii tests indicated good screening capabilities for confirmed sarcopenia, with an AUC of 0.81 (95% CI: 0.77-0.85) and 0.80 (95% CI: 0.76-0.84), respectively. In women, the highest AUC was also achieved using the SARC-F-EBM at 0.79 (95% CI: 0.75-0.82), followed by the Ishii test at 0.77 (95% CI: 0.74-0.81), showing the moderate efficacy. A ranking diagram showed that SARC-F-EBM was most likely to be considered the best method for diagnosing sarcopenia in terms of AUC and sensitivity, regardless of sex. We recommend the SARC-F-EBM for sarcopenia screening in community-dwelling Chinese older adults when respondents are able to answer the questionnaire accurately; otherwise, the Ishii test consisting entirely of objective measures could be used.

SARC-F, SARC-CalF, and SARC-F+EBM as practical predictive tools for the risk of pneumonia in patients with stable schizophrenia-a prospective study

Objectives

Individuals diagnosed with schizophrenia have a high incidence and fatality rates due to pneumonia. Sarcopenia is a contributing factor to the development of pneumonia in patients with schizophrenia. In this study, we examine the effectiveness of three simple screening questionnaires, namely SARC-F, SARC-CalF, and SARC-F + EBM, in predicting the occurrence of pneumonia in stable patients with schizophrenia who are experiencing sarcopenia.

Design

A prospective study.

Setting

Patients with stable schizophrenia patients aged ≥50 years in two psychiatric hospitals in western China.

Methods

Medical data from patients were collected from September 1 to September 30, 2020. Data specifically from patients diagnosed with pneumonia were collected for a period of one year, from October 2020 to October 2021. Three hundred thirty-five stable schizophrenia patients, among whom 229 were males (68.36 %.), were enrolled in the prospective study. The risk of sarcopenia was evaluated using the SARC-F, SARC-CalF, and SARC-F + EBM scores, with values of ≥4, 11, and 12 indicating an elevated risk of sarcopenia. The collected data were analyzed using logistic regression analysis to establish the association between the scores of these screening tools and the risk of pneumonia in individuals with stable schizophrenia.

Results

The rate of pneumonia in stable schizophrenia individuals was 24.48 %. Among the included stable schizophrenia patients, the incidence of pneumonia in individuals with SARC-CalF scores ≥11 was higher than in those with SARC-CalF scores less than 11 (29.91 % vs 14.88 %, P = 0.002). In individuals with SARC-F + EBM scores ≥12, the pneumonia occurrence was higher than that in those with SARC-F + EBM scores less than 12 (37.33 % vs 20.77 %, P = 0.003). However, this pattern was not found in patients with stable schizophrenia who had SARC-F scores of 4 or above and less than 4. Following the implementation of logistic regression data analysis, it has been discovered that persons with SARC-CalF scores greater than or equal to 11 were at a significantly increased risk of having pneumonia compared to patients with SARC-CalF scores less than 11 (OR = 2.441, 95 % CI: 1.367-4.36). After adjusting the possible confounders, patients with SARC-CalF scores ≥11 had a greater danger of pneumonia (OR = 2.518, 95%CI: 1.36-4.665). As a result, it was found that individuals with SACR-F+EBM scores ≥12 were more likely to acquire pneumonia (OR = 2.273, 95%CI: 1.304-3.961) when compared to those with scores <12 (OR = 2.273, 95%CI: 1.304-3.961). The results of this study, which controlled for potential confounders, indicated that patients with SARC-F + EBM scores ≥12 were more inclined to acquire pneumonia (OR = 2.181, 95%CI: 1.182-4.026). However, in stable schizophrenia patients with SARC-F scores ≥4 and < 4, this study has not yet observed a similar pattern for pneumonia risk.

Conclusions and implications

These results demonstrate, in stable adults with schizophrenia, a relationship between pneumonia risk and SARC-F + EBM and SARC-CalF scores. It is, therefore, advised to use these scores to determine whether these patients have pneumonia, especially in hospitals that cannot diagnose sarcopenia.

Comparison of six screening methods for sarcopenia among rural community-dwelling older adults: a diagnostic accuracy study

OBJECTIVE

The objective of this analysis was to determine the diagnostic efficacy of the Ishii test, SarSA-Mod, SARC-F, SARC-Calf, SARC-F+AC, and SARC-Calf+AC for screening for sarcopenia among rural community-dwelling older adults.

METHODS

The AWGS 2019 diagnostic criteria was a diagnostic reference for sarcopenia. There were six screening tools whose accuracy was determined through the use of metrics, including specificity, sensitivity, negative and positive predictive values, and the receiver operating characteristic (ROC) curve.

RESULTS

The study included 551 participants (304 women, age 70.9 ± 4.9 years). The prevalence of sarcopenia was 44.5% in men and 39.1% in women. In males, the sensitivity/specificity of the Ishii test, SarSA-Mod, SARC-F, SARC-Calf, SARC-F+AC, and SARC-Calf+AC screening sarcopenia were 87.3%/65.7%, 98.2%/21.9%, 6.4%/98.5%, 28.2%/91.2%, 33.6%/83.9%, and 84.6%/43.8%, and in females, they were 68.1%/82.2, 100%/23.2%, 16.0%/90.3%, 35.3%/84.3%, 58.8%/61.1%, and 89.9%/42.2%, respectively. In males, the area under the curves of the Ishii test, SarSA-Mod, SARC-F, SARC-Calf, SARC-F+AC, and SARC-Calf+AC were 0.846 (95% CI 0.795-0.889), 0.800 (95% CI 0.745-0.848), 0.581 (95% CI 0.516-0.643), 0.706 (95% CI 0.645-0.762), 0.612 (95% CI 0.548-0.673), and 0.707 (95% CI 0.646-0.763), respectively, and in females, they were 0.824 (95% CI 0.776-0.865), 0.845 (95% CI 0.799-0.883), 0.581 (95% CI 0.524-0.637), 0.720 (95% CI 0.666-0.770), 0.632 (95% CI 0.575-0.686), and 0.715 (95% CI 0.661-0.765), respectively.

CONCLUSION

Our findings demonstrate that the overall accuracy of the Ishii test was best among the six screening tools for sarcopenia screening in rural community-dwelling older adults.

Comparison of Diagnostic Value of the SARC-F and Its Four Modified Versions in Polish Community-Dwelling Older Adults

Purpose

Sarcopenia is associated with adverse outcomes in elderly persons, including functional disability, falls, and even death. Therefore, older adults should be routinely screened for sarcopenia. Due to the unsatisfactory sensitivity of the SARC-F questionnaire, four modified versions have been elaborated: SARC-CalF, SARC-F+EBM, SARC-F+AC, and SARC-CalF+AC. The diagnostic performance of the four modifications of SARC-F has yet to be compared.

Materials and Methods

We performed the sensitivity/specificity analysis and compared the overall diagnostic accuracy of the five questionnaires in 260 community-dwelling volunteers aged ≥ 60 yrs from Poland. The study was performed against three reference standards: the European Working Group on Sarcopenia in Older People (EWGSOP1), EWGSOP2, and modified EWGSOP2 criteria.

Results

The prevalence of sarcopenia based on these criteria was 20.8%, 11.2%, and 17.3%, respectively. Concerning the three reference standards, the sensitivity of SARC-F, SARC-CalF, SARC-F+EBM, SARC-F+AC, and SARC-CalF+AC ranged from 31.5-44.8%, 57.4-65.5%, 48.1-62.1%, 71.4-79.2% and 71.4-79.2%, respectively. The specificity ranged from 86.6-87.4%, 86.1-90.3%, 82.3-84.0%, 69.4-78.2%, and 72.1-79.7%, respectively. The AUCs of SARC-F, SARC-CalF, SARC-F+EBM, SARC-F+AC, and SARC-CalF+AC ranged from 0.643-0.700, 0.757-0.792, 0.740-0.775, 0.767-0.812 and 0.771-0.852, respectively.

Conclusion

The SARC-F questionnaire has low diagnostic accuracy, which limits its usefulness as a sarcopenia screening tool. Incorporating two simple anthropometric measurements, ie, arm and calf circumference, notably improves the diagnostic performance of SARC-F. Based on our results, SARC-CalF+AC seems to be the best screening tool for sarcopenia screening in community-dwelling older adults.

A Nomogram for Optimizing Sarcopenia Screening in Community-dwelling Older Adults: AB3C Model

OBJECTIVES

Sarcopenia is associated with significantly higher mortality risk, and earlier detection of sarcopenia has remarkable public health benefits. However, the model that predicts sarcopenia in the community has yet to be well identified. The study aimed to develop a nomogram for predicting the risk of sarcopenia and compare the performance with 3 sarcopenia screen models in community-dwelling older adults in China.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 966 community-dwelling older adults.

METHODS

A total of 966 community-dwelling older adults were enrolled in the study, with 678 participants grouped into the Training Set and 288 participants grouped into the Validation Set according to a 7:3 randomization. Predictors were identified in the Training Set by univariate and multivariate logistic regression and then combined into a nomogram to predict the risk of sarcopenia. The performance of this nomogram was assessed by calibration, discrimination, and clinical utility.

RESULTS

Age, body mass index, calf circumference, congestive heart failure, and chronic obstructive pulmonary disease were demonstrated to be predictors for sarcopenia. The nomogram (named as AB3C model) that was constructed based on these predictors showed excellent calibration and discrimination in the Training Set with an area under the receiver operating characteristic curve (AUC) of 0.930. The nomogram also showed perfect calibration and discrimination in the Validation Set with an AUC of 0.897. The clinical utility of the nomogram was supported by decision curve analysis. Comparing the performance with 3 sarcopenia screen models (SARC-F, Ishii, and Calf circumference), the AB3C model outperformed the other models regarding sensitivity and AUC.

CONCLUSIONS AND IMPLICATIONS

AB3C model, an easy-to-apply and cost-effective nomogram, was developed to predict the risk of sarcopenia, which may contribute to optimizing sarcopenia screening in community settings.

Association between the mid-upper arm circumference (MUAC) and calf circumference (CC) screening indicators of sarcopenia with the risk of pneumonia in stable patients diagnosed with schizophrenia

AIM

Here, we investigate the relationship between mid-upper arm circumference (MUAC) and calf circumference (CC) screening indicators of sarcopenia and the risk of pneumonia in stable patients diagnosed with schizophrenia.

METHOD

The study is prospective and includes inpatients with schizophrenia from two mental health centers in Western China. The studied screening indicators, MUAC and CC were assessed in standing patients. The relationship between MUAC and CC as sarcopenia screening indicators with the risk of pneumonia in patients with schizophrenia was analyzed by performing a statistical logistic regression analysis.

RESULT

For this study, 339 patients with schizophrenia, aged 50 years and over were recruited. Moreover, four patients with pneumonia that occurred within 1 week of the relapse of schizophrenia were excluded. As a result, only 335 patients were included in the analysis. Pneumonia has been reported in 82 (24.5%) of all included patients with schizophrenia. Our data analysis confirmed that in the male patients, the higher CC was associated with a lower risk of pneumonia (odds ratio [OR] = 0.751, 95% CI: 0.635-0.889). We have divided men into two cohorts following the values of CC. Our analysis further showed that the patients with CC ≥ 34 cm had a lower risk of pneumonia in men (OR = 0.36, 95% CI: 0.163-0.795).

CONCLUSION

We demonstrate that CC is associated with pneumonia risk in stable men with schizophrenia.

Association of Ishii test scores with pneumonia in stable schizophrenic subjects

AIM

We investigated the relationship between the sarcopenia-indicating Ishii test scores and pneumonia risk in stable schizophrenia patients.

METHODS

This prospective investigation involves schizophrenic inpatients from two mental health centers in western China. Patient baseline information was gathered over 1 month from September 1 to 30 in 2020. All pneumonia-related patient information, including diagnosis and treatment, was acquired over 1 year between October 2020 and October 2021. Patients with schizophrenia were screened for sarcopenia utilizing a threshold value established by Ishii et al. Using regression analysis, the link between Ishii test scores and pneumonia risk in schizophrenia patients was investigated.

RESULT

This study recruited 232 males and 107 females with schizophrenia over the age of 50 and older. During a 1-year follow-up period, four patients (3 males and 1 female) acquired pneumonia within 1 week of relapse in schizophrenia; therefore, these patients were excluded from the study. Finally, data were collected for 335 patients. The pneumonia incidences were 29.3% in males and 14.2% in females. Our analysis confirmed that compared to the male schizophrenia patients with Ishii test scores < 105 (non-sarcopenia), those with Ishii test scores ≥ 105 (sarcopenia) exhibited an elevated pneumonia risk (OR = 2.739, 95%CI: 1.406-5.333). Following confounders adjustment, Ishii test scores ≥ 105 remained a risk factor for pneumonia (OR = 2.064, 95%CI: 1.029-4.143). Among females with schizophrenia, the Ishii test scores were not associated with pneumonia risk.

CONCLUSION

In conclusion, our results demonstrated that the Ishii test scores ≥ 105 were strongly associated with pneumonia risk in stable schizophrenic male patients.