COMPARISON OF THE PERFORMANCE OF SCREENING METHODS FOR SARCOPENIA

Transcription

1 COMPARISON OF THE PERFORMANCE OF SCREENING METHODS FOR SARCOPENIA Locquet Médéa 1, Beaudart Charlotte 1, Reginster Jean-Yves 1, Petermans Jean 2, Bruyère Olivier 1 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium ² Geriatric Department, CHU of Liège, Liège, Belgium.

2 CONFLICT OF INTEREST DISCLOSURE My collaborators and I have no potential conflict of interest to report.

3 INTRODUCTION & OBJECTIVES Sarcopenia, a real public health burden: Adverse health consequences Health care expenditure Growing prevalence Need early identification of older adults with sarcopenia, but diagnostic devices are resource-consuming (cost, time, availability, radiation ): development of screening methods. Based on data from the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, our aim was to perform a comparison of the performance of the screening tools in predicting elders at risk of sarcopenia.

4 MATERIAL & METHODS The SarcoPhAge study, an ongoing prospective study whose main goal is to evaluate the long-term health outcomes of sarcopenia (534 individuals aged 65 years or older). Diagnosis of sarcopenia, 3 main assessments: Muscle mass - Dual-Energy X-Ray absorptiometry (DEXA) Muscle strength - hand-dynamometer Physical performance Short Physical Performance Battery (SPPB) Clinical relevance: perform analysis across 5 diagnostic definitions: Cruz-Jentoft et al. (EWGSOP), Fielding et al. (IWGS), Morley et al. (Society of Sarcopenia, Cachexia and Wasting Disorders), Chen et al.(awgs), Studenski et al. (FNIH).

5 MATERIAL & METHODS Five screening methods: 2-step algorithm of the EWGSOP SARC-F questionnaire of Malmstrom & Morley

6 MATERIAL & METHODS Screening grid from Goodman et al.

7 MATERIAL & METHODS Score chart of Ishii et al. Score in men: 0.62x(age-64)-3.09x(grip strength-50)-4.64x(calf circumference-42). Probability in men: 1/1[1+e -(sum score/ ) ]. Score in women: 0.80x(age-64)-5.09x(grip strength-34)-3.28x(calf circumference- 42). Probability in women: 1/1[1+e -(sum score/ ) ]. Prediction equation of Yu et al. Appendicular skeletal muscle mass prediction equation: (weight)- 0.62(BMI)-0.02(age)+5.10(if male). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the curve (AUC)

8 RESULTS Inclusion of 306 older adults. Prevalence sarcopenia: from 6% to 17%. Capacity to identify older adults without sarcopenia Indicators of performance of 5 screening methods across 5 definitions of sarcopenia (n=306) Sensitivity Proportion in % (95%CI) Probability of suffering from sarcopenia in case of positive test Specificity Proportion in % (95%CI) PPV Probability in % (95%CI) Definition of Cruz-Jentoft et al NPV Probability in % (95%CI) 2-stage algorithm of the EWGSOP 33.3 ( ) 91.0 ( ) 42.5 ( ) 87.2 ( ) SARC-F of Malmstrom et al 36.0 ( ) 87.1 ( ) 35.3 ( ) 87.4 ( ) Screening grid of Goodman et al 47.5 ( ) 89.4 ( ) 50.9 ( ) 88.0 ( ) Score chart of Ishii et al 84.3 ( ) 80.9 ( ) 46.7 ( ) 96.3 ( ) Equation of Yu et al 51.0 ( ) 86.7 ( ) 43.3 ( ) 89.8 ( ) Definition of Fielding et al 2-stage algorithm of the EWGSOP 43.2 ( ) 91.1 ( ) 40.0 ( ) 92.1 ( ) SARC-F of Malmstrom et al 43.2 ( ) 86.6 ( ) 30.8 ( ) 91.7 ( ) Screening grid of Goodman et al 45.9 ( ) 88.8 ( ) 36.2 ( ) 92.3 ( ) Score chart of Ishii et al 86.8 ( ) 77.7 ( ) 34.8 ( ) 97.7 ( ) Equation of Yu et al 64.9 ( ) 86.6 ( ) 40.0 ( ) 94.7 ( ) Definition of Morley et al 2-stage algorithm of the EWGSOP 38.9 ( ) 88.5 ( ) 17.5 ( ) 95.9 ( ) SARC-F of Malmstrom et al 55.6 ( ) 85.4 ( ) 19.2 ( ) 96.8 ( ) Screening grid of Goodman et al 66.7 ( ) 87.8 ( ) 25.5 ( ) 97.7 ( ) Score chart of Ishii et al ( ) 74.3 ( ) 34.8 ( ) 97.7 ( ) Equation of Yu et al 83.3 ( ) 84.4 ( ) 25.0 ( ) 98.8 ( ) Definition of Chen et al 2-stage algorithm of the EWGSOP 70.6 ( ) 90.3 ( ) 30.0 ( ) 98.1 ( ) SARC-F of Malmstrom et al 52.9 ( ) 85.1 ( ) 17.3 ( ) 96.8 ( ) Screening grid of Goodman et al 41.2 ( ) 86.2 ( ) 14.9 ( ) 96.1 ( ) Score chart of Ishii et al ( ) 74.1 ( ) 14.5 ( ) ( ) Equation of Yu et al 16.1 ( ) 60.0 ( ) 42.0 ( ) 91.1 ( ) Definition of Studenski et al 2-stage algorithm of the EWGSOP 50.0 ( ) 89.8 ( ) 27.5 ( ) 95.9 ( ) SARC-F of Malmstrom et al 40.9 ( ) 84.9 ( ) 17.3 ( ) 94.9 ( ) Screening grid of Goodman et al 5.88 ( ) 83.5 ( ) 4.26 ( ) 87.6 ( ) Score chart of Ishii et al 90.9 ( ) 74.9 ( ) 21.7 ( ) 99.1 ( ) Equation of Yu et al 36.4 ( ) 81.7 ( ) 13.3 ( ) 94.3 ( ) Probability of not suffering from sarcopenia in case of negative test

9 RESULTS Association between the 5 definitions of sarcopenia and 5 screening tools (n=306) Adjusted OR (95%CI) * P-value * AUC (95%CI) Definition of Cruz-Jentoft et al 2-stage algorithm of the EWGSOP 3.43 ( ) SARC-F of Malmstrom et al 1.30 ( ) ( ) Screening grid of Goodman et al 1.03 ( ) < ( ) Score chart of Ishii et al 1.04 ( ) < ( ) Equation of Yu et al 0.71 ( ) < ( ) Definition of Fielding et al 2-stage algorithm of the EWGSOP 8.25 ( ) < SARC-F of Malmstrom et al 1.47 ( ) < ( ) Screening grid of Goodman et al 1.04 ( ) < ( ) Score chart of Ishii et al 1.05 ( ) < ( ) Equation of Yu et al 0.62 ( ) < ( ) Definition of Morley et al 2-stage algorithm of the EWGSOP 6.61 ( ) SARC-F of Malmstrom et al 1.05 ( ) ( ) Screening grid of Goodman et al 1.06 ( ) < ( ) Score chart of Ishii et al 1.04 ( ) < ( ) Equation of Yu et al 0.58 ( ) < ( ) Definition of Chen et al 2-stage algorithm of the EWGSOP 19.8 ( ) < SARC-F of Malmstrom et al 1.49 ( ) ( ) Screening grid of Goodman et al 1.03 ( ) ( ) Score chart of Ishii et al 1.04 ( ) < ( ) Equation of Yu et al 0.70 ( ) ( ) Definition of Studenski et al 2-stage algorithm of the EWGSOP 5.91 ( ) SARC-F of Malmstrom et al 1.34 ( ) ( ) Screening grid of Goodman et al 0.98 ( ) ( ) Score chart of Ishii et al 1.05 ( ) < ( ) Equation of Yu et al 0.75 ( ) ( ) Discriminate very well sarcopenic from nonsarcopenic subjects a Covariates: age, sex, number of comorbidities, number of drugs and cognitive status included in the regression model

10 DISCUSSION Performance of the tools varies greatly depending on the diagnostic definition of sarcopenia applied: Consensus for defining sarcopenia is essential Each tool significantly associated with sarcopenia diagnosis: Relevance of the use of screening tools in practice Quality of all the tools for sarcopenia screening: When a subject is screened negative, the result can be trusted, avoiding therefore unnecessary diagnostic investigations

11 DISCUSSION Better performances: The score chart of Ishii et al The choice of using a screening tool made according to means and objectives of the practicioner: Efficiency criteria (the rapidity of its application, the simplicity of use and administration or the fact it does not require exacting training of the clinician ) Biaises may have been introduced owing to the sample selection process: may not be fully generalizable

12 KEY TAKE-HOME MESSAGE All the screening tools for sarcopenia performed well to identify with a high degree of reliability individuals who do not suffer from the disease. Promotion of their use in clinical practice would allow early and targeted management of sarcopenia to prevent muscular disability.

13 THANK YOU Locquet Médéa Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium