Prognostic value of a rapid sarcopenia measure in acutely ill older adults

Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index-adjusted values

BACKGROUND

Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white).

METHODS

Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women).

RESULTS

Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184).

CONCLUSION

Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.

Combination of Parenteral Amino Acid Infusion and Intermittent Loading Exercise Ameliorates Progression of Postoperative Sarcopenia in Rat Model

Postoperative sarcopenia is associated with poor outcomes in hospitalized patients. However, few studies have focused on short-term postoperative sarcopenia. Furthermore, the influence of nutritional management using amino acids (AAs) comprising a peripheral parenteral nutrition (PPN) solution and its combination with exercise (Exc) is unclear. Hence, we established a postoperative sarcopenic rat model to evaluate the effects of parenteral AA infusion combined with Exc on skeletal muscles and investigate the underlying mechanisms involved in the amelioration of muscle atrophy. Male F344 rats underwent surgery followed by hindlimb suspension (HS) for 5 days. The rats were divided into AA (-), AA (+), AA (-)-Exc, and AA (+)-Exc groups. They were continuously administered a PPN solution with or without AA at 98 kcal/kg/day. The Exc groups were subjected to intermittent loading for 1 h per day. Postoperative sarcopenic rats exhibited decreased muscle strength and mass and an upregulated ubiquitin-proteasome system, autophagy-lysosome system, and fast-twitch fiber-related genes, especially in the AA (-) group. The AA (+)-Exc group exhibited attenuated decreased muscle strength, increased gastrocnemius mass, and a suppressed upregulation of muscle atrophy- and fast-twitch fiber-related genes. Therefore, parenteral AA infusion combined with Exc may be effective in preventing postoperative sarcopenia in hospitalized patients.

Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability

AIM

How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability.

METHODS

This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group.

RESULTS

This study included 456 patients with acute stroke (median age, 80 years). In the premorbid-disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid-disability group (β = -0.054, P = 0.346).

CONCLUSIONS

The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359-363.

The Impact of Sarcopenia Risk on Postoperative Walking Independence in Older Adults Undergoing Total Joint Arthroplasty

BACKGROUND AND PURPOSE

Sarcopenia is known to be associated with poor outcomes after arthroplasty; however, no study has reported the relationship between sarcopenia and postoperative walking independence. This study aimed to determine the impact of sarcopenia risk screening using the SARC-CalF questionnaire and calf circumference on the time to walk independently after total hip or knee arthroplasty in older patients.

METHODS

We included 599 nonobese patients aged 65 years and older who underwent unilateral and primary total hip or knee arthroplasty. Preoperative sarcopenia risk was assessed using the SARC-CalF or calf circumference. The outcome of this study was the time to independent walking after surgery; it was calculated as the number of days from the date of surgery to the date when the patient was able to walk independently. The association between preoperative sarcopenia risk and time to independent walking after surgery was analyzed using Kaplan-Meier curves and Cox proportional hazards models.

RESULTS

Among the 599 patients undergoing total joint arthroplasty, 175 (29.2%) were determined to be at risk of sarcopenia using SARC-CalF and 193 (32.2%) using calf circumference. The Kaplan-Meier curve showed that sarcopenia risk assessed by SARC-CalF or calf circumference was associated with a prolonged time to independent walking in patients undergoing hip arthroplasty (log-rank test, P < .001 and P < .001, respectively). In patients undergoing hip arthroplasty, the Cox proportional hazards model showed that SARC-CalF score of 11 points and greater or a calf circumference less than the cutoff was a risk factor for delayed time to independent walking (hazard ratios: 0.55 and 0.57, P < .001 and P = .001, respectively). There was no association between preoperative sarcopenia risk and postoperative time to independent walking in patients who underwent knee arthroplasty.

CONCLUSIONS

Sarcopenia screening tools, such as SARC-CalF or calf circumference, should be useful for planning postoperative rehabilitation in older adults scheduled for hip arthroplasty. However, the accuracy of SARC-CalF or calf circumference measurement in patients scheduled for knee arthroplasty may be low.

Impact of body composition on patient prognosis after SARS-Cov-2 infection

BACKGROUND

Since the first outbreak of coronavirus disease 2019 (COVID-19), it has been reported that several factors, including hypertension, type 2 diabetes mellitus, and obesity, have close relationships with a severe clinical course. However, the relationship between body composition and the prognosis of COVID-19 has not yet been fully studied.

METHODS

The present study enrolled 76 consecutive COVID-19 patients with computed tomography (CT) scans from the chest to the pelvis at admission. The patients who needed intubation and mechanical ventilation were defined as severe cases. Patients were categorized into four groups according to their body mass index (BMI). The degree of hepatic steatosis was estimated by the liver/spleen (L/S) ratio of the CT values. Visceral fat area (VFA), psoas muscle area (PMA), psoas muscle mass index (PMI), and intra-muscular adipose tissue content (IMAC) were measured by CT scan tracing. These parameters were compared between non-severe and severe cases.

RESULTS

Severe patients had significantly higher body weight, higher BMI, and greater VFA than non-severe patients. However, these parameters did not have an effect on disease mortality. Furthermore, severe cases had higher IMAC than non-severe cases in the non-obese group.

CONCLUSIONS

Our data suggest high IMAC can be a useful predictor for severe disease courses of COVID-19 in non-obese Japanese patients, however, it does not predict either disease severity in obese patients or mortality in any obesity grade.

Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma

OBJECTIVE

To evaluate handgrip strength (HGS) as a diagnostic tool for frailty risk in elderly patients with asthma, as well as to investigate the prevalence of frailty in this population.

METHODS

This was a cross-sectional study including 96 patients ≥ 60 years of age diagnosed with moderate to severe asthma and treated at a tertiary referral center in Brazil. We measured HGS using a calibrated hydraulic hand dynamometer. We used a frailty scale and the AUC to assess the diagnostic accuracy of the HGS test.

RESULTS

The median age of participants was 67 years. Most (78%) were women and non-White (91%) of low socioeconomic status. HGS identified those at risk for frailty, with an AUC of 71.6% (61.5-80.4%; p < 0.002), as well as a sensitivity of 73.58% and a specificity of 67.53%, on the basis of a cutoff of ≤ 19 kgf.

CONCLUSIONS

HGS appears to be a simple, reliable tool for clinicians to determine frailty risk in older asthma patients in a point-of-care setting.

The Relationship between Sarcopenia and Injury Events: A Systematic Review and Meta-Analysis of 98,754 Older Adults

The main purpose of this study was to investigate the relationship between sarcopenia and injury events (falls, fractures, hospitalization, disability, and death). This study systemically searched the literature from Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library and analyzed the collected literature using the random effects model to demonstrate the relationship between sarcopenia and injury events. This study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and collected a total of 38 prospective studies, and the results showed that, when compared to robust individuals, the risk of injury events for older individuals with sarcopenia was significantly higher for fractures (HR = 9.66, CI: 5.07-18.38), hospital admissions (HR = 11.80, CI: 4.86-28.65), and death (HR = 9.57, CI: 3.17-28.94). In consideration of the negative impact of sarcopenia on the subsequent health of older adults, professional nursing personnel should assess older adults for sarcopenia as early as possible and propose relevant care policies to further reduce negative health impacts.

Association between sarcopenia and cognitive impairment in the older people: a meta-analysis

PURPOSE

The effects of sarcopenia on the older people are profound, increasing the risk of adverse outcomes for older patients. Although the substantial impact of sarcopenia on maintaining functional independence and adverse health outcomes has been described many times in the past, the link between sarcopenia and cognitive impairment in older adults remains lacking in evidence and controversial. Therefore, we conducted a comprehensive search of available national and international databases and carried out a meta-analysis to examine the association between sarcopenia in older people and cognitive impairment.

METHODS

Relevant experiments had been recognized via looking out electronic databases and conference sessions. The present study included case-control, cohort, or cross-sectional studies of the association between sarcopenia and cognitive impairment in the older people.

RESULTS

The meta-analysis included 26 articles and 18,788 participants were involved after assessment of eligibility. The results of this meta-analysis showed that the risk of developing cognitive impairment was significantly higher in patients with sarcopenia than in those without sarcopenia [OR = 1.75; 95% CI = 1.57, 1.95; P < 0.00001], MMSE score of sarcopenia group was lower than that of non-sarcopenia group, the difference was statistically significant [OR = - 2.23; 95% CI = - 2.48, - 1.99; P < 0.00001].

CONCLUSION

Overall, this meta-analysis showed an association between sarcopenia and cognitive impairment in the older people, demonstrating a significant association between sarcopenia and cognitive impairment. This suggested that providing comprehensive sarcopenia screening and active prevention for the older people with cognitive decline has certain clinical value for improving the quality of life of the older people.

Nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to activities of daily living in older inpatients who are judged as severely low body mass index in the Global Leadership Initiative on Malnutrition criteria

BACKGROUND & AIMS

Which factors are related to activities of daily living (ADL) in older inpatients who are judged as the severely low body mass index (BMI) in the Global Leadership Initiative on Malnutrition (GLIM) criteria is unclear. This study aimed to examine the related factors to ADL in older inpatients who are judged as severely low BMI in the GLIM criteria.

METHODS

This cross-sectional study included 377 inpatients aged ≥70 years. We divided the participants into the following three groups: the severely low BMI group (<17.8 kg/m²) (n = 106), moderately low BMI group (≥17.8 to < 20.0 kg/m²) (n = 87), and normal BMI group (≥20.0 kg/m²) (n = 184). ADL were assessed using the motor-Functional Independence Measure (FIM). Multiple regression analyses were used to identify the factors independently associated with the motor-FIM score in each group.

RESULTS

The Food Intake Level Scale (FILS) and Geriatric Nutritional Risk Index (GNRI) were significantly related to the motor-FIM score of the severely low BMI group. The FILS, GNRI, updated Charlson comorbidity index (UCCI), and quadriceps echo intensity were significantly related to the motor-FIM score of the moderately low BMI group. The FILS, GNRI, UCCI, quadriceps thickness, and subcutaneous fat thickness of the thigh were significantly related to the motor-FIM score of the normal BMI group.

CONCLUSIONS

Our findings indicate that nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to ADL in older inpatients who are judged as severely low BMI in the GLIM criteria. Intervention for nutritional and swallowing statuses may be prioritized over an exercise intervention to improve ADL of older inpatients who are judged as severely low BMI.

Validating intrinsic capacity to measure healthy aging in an upper middle-income country: Findings from the ELSI-Brazil

Background

While efforts have been made to validate intrinsic capacity (IC) as a multidimensional indicator of healthy aging in high-income countries, we still need evidence from lower-income countries. We examined associations of IC with wide ranges of activities of daily living in a nationally representative sample of Brazilians aged≥50 years.

Methods

This cross-sectional analysis included 7175 participants from the Brazilian Longitudinal Study of Aging. IC domains (cognitive, psychological, sensory, locomotor, and vitality) were determined using self-reported and physical performance measures. IC was operationalized through factorial analysis. We investigated associations of IC and its domains with functional ability in basic, instrumental, and advanced activities of daily living (ADL, IADL, and AADL) using logistic regressions adjusted for sociodemographic, clinical, and modifiable risk factors.

Findings

The IC bi-factorial model revealed satisfactory goodness-of-fit. Preserved ability in ADL and IADL, respectively, ranged from 69% and 29% to 89% and 74% across IC quartiles. In adjusted analyses, every standard deviation increment in IC composite score was associated with almost twice the odds of preserved ADL (OR=1·72; 95%CI=1·54-1·93), preserved IADL (OR=1·95; 95%CI=1·77-2·16), and high performance in AADL (OR=1·79; 95%CI=1·59-2·00). Similar results were reported using the IC domains as predictors. Although age, race/ethnicity, and education did not modify associations of IC with functional ability, we found sex differences with stronger relationships of IC with preserved ADL or IADL in females.

Interpretation

Our results support IC validity and reliability to measure healthy aging in diverse socioeconomic and cultural settings. Incorporating IC in routine practices can promote holistic and person-centered care approaches in aging societies.

Funding

The Brazilian Ministry of Health and Ministry of Science, Technology, Innovation, and Communication.

Accuracy of Calf Circumference Measurement, SARC-F Questionnaire, and Ishii's Score for Screening Stroke-Related Sarcopenia

Objective

The purpose of this study was to investigate the accuracy of sarcopenia diagnosis in patients with stroke using calf circumference (CC), SARC-F questionnaire, and Ishii's score in comparison with the Asian Working Group for Sarcopenia 2019 (AWGS) sarcopenia diagnostic criteria.

Materials and Methods

In this cross-sectional study, a total of 364 consecutive patients with stroke were enrolled and evaluated with the CC measurement, SARC-F questionnaire, and Ishii's score. The diagnostic accuracy was analyzed.

Results

Based on the AWGS criteria, sarcopenia was present in 180 (49.5%) patients, with an age range of 49–74 (mean 63 ± 14.7) years. In all patients, the cutoff value of CC in the accuracy of diagnosing sarcopenia was 30.5 cm, with an AUC of 0.85, sensitivity of 81.8%, specificity of 90.1%, Kappa value of 0.72, and Youden index of 0.72. In the accuracy of diagnosing sarcopenia in all patients, Ishii's score had a cutoff value of 118, AUC of 0.78, sensitivity of 90.1%, specificity of 36.0%, Kappa value of 0.4, and Youden index of 0.55. For accuracy of diagnosing sarcopenia, the SARC-F questionnaire had a cutoff value of 5, AUC of 0.731, sensitivity of 94.7%, specificity of 40%, Kappa value of 0.34, and Youden index of 0.41.

Conclusions

Based on the AWGS criteria, calf circumference measurement has the optimal performance in screening stroke-related sarcopenia compared with the SARC-F questionnaire and Ishii's score. In patients with stroke, the cutoff value of calf circumference for sarcopenia is < 31 cm in men and 30 cm in women, and with an AUC of 0.85.

The association between low calf circumference and mortality: a systematic review and meta-analysis

PURPOSE

Low calf circumference is an important indicator of malnutrition and has been widely studied, especially among older adults. However, data on the association between low calf circumference and mortality have been inconsistent. This systematic review was aimed to quantify this association.

METHODS

The internet databases (PubMed, Embase, ScienceDirect and Cochrane Library databases) were systematically searched from inception to November 01, 2021 for studies investigating the association between low calf circumference and mortality. A random effects model was adopted to pool the relevant data.

RESULTS

Low calf circumference was associated with a higher risk of mortality than normal calf circumference, with a pooled HR of 2.42 (95% CI 1.97-2.97, I² = 74.3%). In addition, this association between low calf circumference and morality was still statistically significant in the subgroup analysis across different settings, including hospitals (pooled HR = 2.63, 95% CI 1.93-3.58), nursing homes (pooled HR = 2.49, 95% CI 1.76-3.54), and communities (pooled HR = 2.22, 95% CI 1.60-3.07). Other subgroup analyses based on different cutoffs of calf circumference showed that, compared to individual with normal calf circumference, participants with low calf circumference had an increased risk of mortality (pooled HR = 2.66, 95% CI 2.06-3.43) when using the Asian Working Group for Sarcopenia (AWGS) criterion (≤ 34 cm for males and ≤ 33 cm for females). Similar results were found when the Mini Nutritional Assessment (MNA) criterion (≤ 31 cm) was used, with a pooled HR of 2.11 (95% CI 1.59-2.81).

CONCLUSION

Calf circumference, which is simple and convenient to measure, could be used to stratify the high-risk group, as low calf circumference was significantly associated with mortality among patients. Interventions, including exercise and nutrition programs, could be conducted promptly once low calf circumference is detected.

Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

OBJECTIVES

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

METHODS

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

RESULTS

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

CONCLUSIONS

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

Sarcopenia affects activities of daily living recovery and hospitalization costs in older adults in convalescent rehabilitation wards

PURPOSE

This study aimed to investigate the impact of sarcopenia on activities of daily living (ADL) recovery and hospitalization costs in older patients admitted to convalescent rehabilitation wards.

METHODS

This prospective cohort study included 104 patients aged ≥ 65 years who were admitted to convalescent rehabilitation wards. The primary outcome was ADL recovery as evaluated by the Functional Independence Measure (FIM) efficiency during hospitalization, and the secondary outcome was hospital-related costs. Univariate and multivariate analyses were performed to identify whether sarcopenia was associated with FIM-motor efficiency and hospitalization costs.

RESULTS

Among the patients, 68.3% were females, and the mean age was 82.3 ± 8.3 years. The prevalence of sarcopenia was 73.1%. The FIM-motor efficiency score was significantly lower in patients with sarcopenia (median 0.38; interquartile range 0.27-0.52) than in those without sarcopenia (median 0.55; interquartile range 0.34-0.87) (P = 0.009). Hospitalization costs were higher in patients with sarcopenia (32,813 ± 15,184 dollars) than in those without sarcopenia (26,879 ± 10,248 dollars) (P = 0.058). Multivariate analysis showed that sarcopenia was independently associated with FIM-motor efficiency (standardized β =  - 0.236, P = 0.014, R2 = 0.40) and hospitalization costs (standardized β = 0.15, P = 0.027, R2 = 0.70) after adjusting for confounding factors.

CONCLUSION

We found that sarcopenia reduces the FIM-motor efficiency and increases direct hospitalization costs in older patients admitted to convalescent rehabilitation wards. Therefore, it is necessary to design interventions to prevent sarcopenia and improve the efficiency of ADL recovery and reduce direct hospitalization cost.

Pectoralis major muscle quantification by cardiac MRI is a strong predictor of major events in HF

Clinical overt cardiac cachexia is a late ominous sign in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). The main goal of this study was to assess the feasibility and prognostic significance of muscle mass quantification by cardiac magnetic resonance (CMR) in HF with reduced LVEF. HF patients with LVEF < 40% (HFrEF) referred for CMR were retrospectively identified in a single center. Key exclusion criteria were primary muscle disease, known infiltrative myocardial disease and intracardiac devices. Pectoralis major muscles were measured on standard axial images at the level of the 3rd rib anteriorly. Time to all-cause death or HF hospitalization was the primary endpoint. A total of 298 HF patients were included (mean age 64 ± 12 years; 76% male; mean LVEF 30 ± 8%). During a median follow-up of 22 months (IQR: 12-33), 67 (22.5%) patients met the primary endpoint (33 died and 45 had at least 1 HF hospitalization). In multivariate analysis, LVEF [Hazard Ratio (HR): 0.950; 95% Confidence Interval (CI): 0.917-0.983; p = 0.003), NYHA class I-II vs III-IV (HR: 0.480; CI: 0.272-0.842; p = 0.010), creatinine (HR: 2.653; CI: 1.548-4.545; p < 0.001) and pectoralis major area (HR: 0.873; 95% CI: 0.821-0.929; p < 0.001) were independent predictors of the primary endpoint, when adjusted for gender and NT-pro-BNP levels. Pectoralis major size measured by CMR in HFrEF was independently associated with a higher risk of death or HF hospitalization. Further studies to establish appropriate age and gender-adjusted cut-offs of muscle areas are needed to identify high-risk subgroups.

Comparison of five sarcopenia screening tools in preoperative patients with gastric cancer using the diagnostic criteria of the European Working Group on Sarcopenia in Older People 2

OBJECTIVES

The aim of this study was to compare the performance of five sarcopenia screening tools in preoperative patients with gastric cancer, including strength, assistance with walking, rise from a chair, climb stairs, and falls; strength, assistance with walking, rise from a chair, climb stairs, falls, and calf circumference (SARC-CalF); Ishii score chart; short version of the mini sarcopenia risk assessment; and full version of the mini sarcopenia risk assessment.

METHODS

We conducted a cross-sectional study of consecutive patients undergoing a gastrectomy between May 2020 and October 2020. Sarcopenia was diagnosed per the diagnostic criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Data on the five sarcopenia screening tools, patient characteristics, nutrition risk screening 2002, and diagnostic indicators of sarcopenia were collected preoperatively, and pathological characteristics of the tumor were collected postoperatively. Based on the EWGSOP2 criteria, the clinical validity of the sarcopenia tools was measured using sensitivity, specificity, and predictive value. A receiver operator characteristic curve and area under curve were applied to compare the overall screening accuracy, and a Youden index was calculated to determine the optimal cutoff value of each tool.

RESULTS

We included 260 participants age 62.38 ± 11.21 y. Based on the EWGSOP2 criteria, the prevalence of sarcopenia and severe sarcopenia were 8.46% and 4.62%, respectively. Moreover, the prevalence of sarcopenia risk ranged from 3.46% to 73.85% based on the five screening tools. Of these tools, SARC-CalF had the largest area under the curve (0.896) with moderate-to-high sensitivity (86.36%) and high specificity (92.86%). For SARC-CalF, the cutoff value of 10 reached the highest Youden index, and the corresponding sensitivity and specificity were 81.82% and 93.44%, respectively.

CONCLUSION

Among the above five screening tools, SARC-CalF appeared to be the optimal choice to screen sarcopenia in preoperative patients with gastric cancer.

Association Between Low Handgrip Strength and 90-Day Mortality Among Older Chinese Inpatients: A National Multicenter Prospective Cohort Study

Background: The knowledge of the association between low handgrip strength and mortality among older Chinese inpatients is limited. Given China's aging society, a great number of older adults require hospital admission. Objective: To explore the association between low handgrip strength and 90-day mortality, providing evidence for clinicians to predict the risk of mortality and improve clinical outcomes for older inpatients. Materials and Methods: We conducted a national multicenter cohort study with a baseline survey from October 2018 to February 2019 and followed up for 90 days to record mortality outcomes. The assessment of handgrip strength was conducted using a hand dynamometer with the cutoff (handgrip strength < 28 kg for men and < 18 kg for women) to define low handgrip strength. Multivariable logistic regression analysis was applied to explore the association between low handgrip strength and 90-day mortality. Results: A total of 8,910 older Chinese inpatients [mean (SD) age, 72.39 (5.68) years; 3,750 women (42.09%)], with a prevalence of low handgrip strength, at 49.57%, were included. Compared to inpatients with normal handgrip strength, inpatients with low handgrip strength were older, had less education, more were female, had lower activities of daily living (ADL) score, had lower BMI, higher frailty, higher rates of depression, and poorer cognitive function (all p < 0.05). At 90 days, after adjusting for gender, age, education, frailty, depression, ADL score, malnutrition, and diagnosis, low handgrip strength was independently associated with 90-day mortality, compared to normal handgrip strength (OR = 1.64, 95% CI:1.14-2.37; P = 0.008). Additionally, subgroup and interaction analysis showed a significant interaction effect (P = 0.031) between two age groups (65-74 years older vs. ≥ 75 years old), with the OR being 3.19 (95%CI:2.07-4.93) and 1.49 (95%CI:0.87-2.55), respectively. Conclusion: Older Chinese inpatients with low handgrip strength had a 1.64-fold risk of 90-day mortality, compared to those with normal handgrip strength, indicating that clinicians need to screen early for handgrip strength and recommend corresponding interventions, such as resistance training and nutrition, as a priority for older inpatients. Clinical Trial Registration: Chinese Clinical Trial Registry, Identifier: ChiCTR1800017682.

A 2-min cognitive screener for predicting 1-year functional recovery and survival in older adults after hip fracture repair

BACKGROUND

Implementing cognitive assessment in older people admitted to hospital with hip fracture - lying in bed, experiencing pain - is challenging. We investigated the value of a quick and easy-to-administer 10-point cognitive screener (10-CS) in predicting 1-year functional recovery and survival after hip surgery.

METHODS

Prospective cohort study comprising 304 older patients (mean age=80.3±9.1 years; women=72%) with hip fracture consecutively admitted to a specialized academic medical center that supports secondary hospitals in Sao Paulo Metropolitan Area, Brazil. The 10-CS, a 2-minute bedside tool including temporal orientation, verbal fluency, and three-word recall, classified patients as having normal cognition, possible cognitive impairment, or probable cognitive impairment on admission. Outcomes were time-to-recovery activities of daily living (ADLs; Katz index) and mobility (New Mobility Score), and survival during 1-year after hip surgery. Hazard models, considering death as a competing risk, were used to associate the 10-CS categories with outcomes after adjusting for sociodemographic and clinical measures.

RESULTS

On admission, 144 (47%) patients had probable cognitive impairment. Compared to those cognitively normal, patients with probable cognitive impairment presented less postsurgical recovery of ADLs (77% vs. 40%; adjusted sub-hazard ratio [HR]=0.44; 95%CI=0.32-0.62) and mobility (50% vs. 30%; adjusted sub-HR=0.52; 95%CI=0.34-0.79), and higher risk of death (15% vs. 40%; adjusted HR=2.08; 95%CI=1.03-4.20) over 1-year follow-up.

CONCLUSIONS

The 10-CS is a strong predictor of functional recovery and survival after hip fracture repair. Cognitive assessment using quick and easy-to-administer screening tools like 10-CS can help clinicians make better decisions and offer tailored care for older patients admitted with hip fracture.

Comparing the Performance of Calf Circumference, Albumin, and BMI for Predicting Mortality in Immobile Patients

Background

Immobile patients often suffer from malnutrition and low calf circumference (CC), a potential surrogate marker of low muscle mass, which has been widely explored as a link with mortality among patients with inconsistent results. In addition, studies comparing CC, BMI, and albumin to predict mortality among immobile patients are limited. The aim of our study was to compare the performance of these three parameters for predicting mortality among immobile patients.

Methods

This is a secondary analysis of our previous study consisting of immobile patients, age>18 years. Data were collected between November 2015 and March 2016 by trained nurses through a case report form (CRF) that included clinical data and sociodemographic variables. In addition, anthropometric parameters, including body weight, height and calf circumference, were also measured. The outcome of our study was mortality with follow-up length being 90 days. Multivariate linear and logistic regression analysis were adopted to identify the association between CC and mortality, and a receiver operating characteristic curve analysis was also used to compare the performance of CC, BMI, and albumin.

Results

Of the 387 patients who were included (51.42% male), with an average age of 61.22 (SD=15.18), the prevalence of mortality was 5.43%. The results showed that, after full adjustment, calf circumference was a protective factor for reducing the risk of mortality (OR=0.79; 95%CI:0.65–0.96). Meanwhile, immobile patients with low calf circumference had an increased risk of mortality, compared to those whose condition was normal (OR=4.24; 95%CI:1.07–16.74). Receiver operating characteristic curve analysis showed that CC combined with albumin (AUC=0.812; 95% CI=0.733–0.890) had the highest AUC value compared to calf circumference (AUC=0.759; 95%CI:0.662–0.856), BMI (AUC=0.653; 95%CI:0.538–0.767) and albumin (AUC=0.735; 95% CI:0.638–0.832), respectively, in predicting mortality in immobile patients.

Conclusion

The relationship between calf circumference and mortality was significantly negative and low calf circumference was associated with a high risk of 90-day mortality, compared to those with normal calf circumference. The combined calf circumference with albumin had good discrimination in predicting mortality among immobile patients. Therefore, it can routinely be used in a clinical setting by medical staff to predict mortality in immobile patients, as it is easy to obtain.

Predictors of sarcopenia in young hospitalized patients living with HIV

The prevalence of sarcopenia in hospitalized people living with HIV is underdiagnosed, as assessment instruments are not always available. This study aimed to identify factors related to sarcopenia, correlating their anthropometric and clinical markers in hospitalized people living with HIV. This was an observational cross-sectional clinical study, carried out from September 2018 through October 2019. Handgrip strength, muscle mass index, calf circumference and gait speed test were evaluated in recruited patients within three days of hospital admission. The sample consisted in 44 patients, mostly men (66%), black (68%), young adults (41.65 ± 12.18 years) and immunodeficient (CD4 cell count 165 cells/mm³ [34.25–295.5]). Sarcopenia was present in 25% of the sample. Calf circumference showed a significant correlation with CD4 cell count and viral load (p < 0.05) while handgrip strength and gait speed test did not. Calf circumference > 31 cm and gait speed test > 0.8 m/s reduced the chance of sarcopenia by 60% (OR = 0.396 [−1.67 to −0.18]; p < 0.05) and 98% (OR = 0.02 [−8.16 to 0.13]; p < 0.05) respectively. Calf circumference > 31 cm and gait speed test > 0.8 m/s are associated with a reduced chance of sarcopenia in hospitalized HIV patients.

Validity of calf circumference for estimating skeletal muscle mass for Asian patients after stroke

OBJECTIVES

The aims of this study was to determine the optimal cutoff values of non-paretic calf circumference (CC) that are indicative of low skeletal muscle mass and examine the association between a low CC and rehabilitation outcomes.

METHODS

This was a retrospective cohort study that included 628 patients in convalescent rehabilitation wards in Japan. Patients in post-stroke rehabilitation who were ≥20 y of age were included. We examined the agreement between CC on the non-paretic side and a low skeletal muscle mass index (SMI) measured by bioelectrical impedance analysis. We also confirmed the correlation between sarcopenia defined by CC and handgrip strength, and sarcopenia according to Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Functional Independent Measure (FIM) at discharge and discharge to home outcomes were compared between patients with a high CC and those with a low CC.

RESULTS

Of the 628 patients included in the study, 408 (170 women; mean age, 72 y) were analyzed. The optimal cutoff values of CC were 33 cm for men (sensitivity and specificity, 0.798 and 0.840, respectively) and 32 cm for women (0.847 and 0.818, respectively). The sensitivity and specificity of CC-based sarcopenia against the AWGS criteria were 0.752 and 1.000 for men and 0.800 and 1.000 for women, respectively. Patients with a low CC had a significantly lower FIM and proportion of home discharge than those with a high CC.

CONCLUSIONS

The optimal cutoff values of non-paretic CC for a low SMI were 33 cm for male and 32 cm for female Asian stroke rehabilitation patients. Sarcopenia can be defined using CC instead of SMI.