Study On Influencing Factors Of Sarcopenia And Applicability Of Screening Tools For Sarcopenia Among Maintenance Hemodialysis Patients

ObjectiveTo investigate the current situation of sarcopenia and analyze its influencing factors,and to compare the performance of five screening tools for sarcopenia among maintenance hemodialysis(MHD)patients refer to the diagnostic criteria of sarcopenia revised by Asia Working Group for Sarcopenia(AWGS)in 2019.Thus,this study can provide a scientific reference for clinical medical staff to identify the individuals at high risk for sarcopenia in MHD patients early and take preventive intervention measures in time.MethodsA method of convenience sampling was used to select patients who received MHD treatment in the blood purification center of a tertiary hospital in Qingdao from October2020 to April 2021.Patients’ grip strength and walking speed were tested before dialysis.The general information questionnaire,modified quantitative subjective global assessment questionnaire,Beck Hopelessness Scale,Strength,Assistance with Walking,Rise from a Chair,Climb Stairs and Falls(SARC-F)questionnaire,SARC-F combined with Calf Circumference(SARC-Cal F)questionnaire,SARC-F adding Elderly and Body Mass Index Information(SARC-F+EBM)questionnaire,Mini Sarcopenia Risk Assessment-7 items(MSRA-7)questionnaire,Mini Sarcopenia Risk Assessment-5 items(MSRA-5)questionnaire were used to investigate during dialysis.Patients’ appendicular skeletal muscle mass and calf circumference were measured after dialysis.SPSS 22.0 and Med Calc 19.6 software were used for data analysis.Qualitative data were described by frequency and constituent ratio.Measurement data obeying the normal distribution were described by the mean and standard deviation,and measurement data that don’t obey normal distribution were described by the median and quartile spacing.Rank sum test,chi-square test,Fisher’s exact probability method and independent sample t-test were used to analyze the differences of demographic data,disease-related data,laboratory indexes,dialysis-related indexes,hopelessness level and nutritional status between sarcopenia group and non-sarcopenia group.Binary multivariate Logistic regression was used to analyze the independent influencing factors of sarcopenia in MHD patients.The receiver operating characteristic curve was drawn,and the area under the curve(AUC)was used to evaluate the overall performance of five screening tools for sarcopenia in MHD patients.De Long test was used to test whether there were differences in the AUC of the five screening tools.The optimal cut-off value of five screening tools were determined according to the principle of maximum Yoden index.The sensitivity,specificity,Kappa value,positive predictive value and negative predictive value of the five screening tools at the original cut-off value and the optimal cut-off value were calculated respectively.Results1.A total of 340 MHD patients were enrolled in this study,of whom 84(24.71%)were diagnosed as sarcopenia.There were statistically significant differences in age,body mass index,regular exercise,diabetes,albumin,prealbumin,creatinine,hypersensitive C-reactive protein,hopelessness level,nutritional status of patients between sarcopenia group and nonsarcopenia group(P<0.05).Binary Logistic regression analysis showed that age,with or without diabetes,hypersensitive C-reactive protein,hopelessness level and nutritional status were independently associated with sarcopenia in MHD patients(P<0.05).2.The AUC of SARC-F questionnaire,SARC-Cal F questionnaire,SARC-F+EBM questionnaire,MSRA-7 questionnaire and MSRA-5 questionnaire were 0.812,0.872,0.796,0.759,0.786 refer to the diagnostic results of sarcopenia,respectively.The optimal cut-off value of them for screening sarcopenia were 2 point,11 point,11 point,25 point,45 point,respectively.Under the optimal cut-off value,the sensitivity of above five screening tools were 61.90%,78.57%,64.29%,55.95%,77.38%;and the specificity were 86.72%,89.84%,84.77%,84.37%,69.53%;and the Kappa value were 0.482,0.663,0.473,0.398,0.380;and the positive predictive value were 60.47%,71.74%,58.07%,54.02%,45.46%;and the negative predictive value were 86.72%,92.74%,87.85%,85.38%,90.36%,respectively.Furthermore,the AUC of SARC-Cal F questionnaire was larger than the other four screening tools,and the differences were statistically significant(Z(28)2.248～3.451,P<0.05).Conclusion1.The prevalence of sarcopenia is high in MHD patients.Age,with or without diabetes,hypersensitive C-reactive protein,hopelessness level and nutritional status are influencing factors of sarcopenia in MHD patients.Clinical medical staff can implement individualized preventive intervention programs from the aspects of active monitoring and control of blood sugar,reducing the level of inflammatory cytokines,improving hopelessness and nutritional status to reduce the occurrence of sarcopenia in MHD patients.2.The accuracy of the five screening tools for sarcopenia in MHD patients is moderate,and SARC-Cal F questionnaire has the highest accuracy of all screening tools.Furthermore,SARC-Cal F questionnaire has high sensitivity and specificity at the optimal cut-off value,so it is more suitable for being used to identify the individuals at high risk for sarcopenia in MHD patients than the other four screening tools.