| Objective: To investigate the incidence of sarcopenia in maintenance hemodialysis patients in a blood purification center,and to compare the screening effects of different sarcopenia assessment tools on maintenance hemodialysis patients.At the same time,the current quality of life and nutritional status of maintenance hemodialysis patients were investigated,and the risk factors affecting their quality of life were analyzed.Methods: Patients undergoing maintenance hemodialysis at a comprehensive tertiary care teaching hospital hemodialysis center in Anhui Province from December 2021 to September 2022 were selected.A stratified and convenience sampling method was used to select the study subjects,and a cross-sectional survey was conducted to compare the accuracy of diagnostic tests for those who met the nadir criteria,respectively.The comparative diagnostic test accuracy study included the application of multiple sarcopenia assessment tools and analysis of the most applicable maintenance hemodialysis sarcopenia assessment tools based on the 2019 Asian Sarcopenia Working Group sarcopenia diagnostic criteria;the cross-sectional survey included the use of a general information questionnaire,a quality of life questionnaire,and a nutritional assessment questionnaire,and analysis of risk factors for quality of life.Results: 1.A total of 186 patients on maintenance hemodialysis were included in this study,including 93 males and 93 females,aged ≤45 years 47(25.3%),46-59 years 81(43.5%),and ≥60 years 58(31.2%)According to the 2019 Asian Working Group on Myasthenia Gravis diagnostic criteria,the incidence of myasthenia gravis in patients with MHD was 33.3%,the incidence in males was 31.2%,and the incidence in women was 35.5%.The incidence was 17.0% for ≤45 years,35.8% for 46-59 years,and 43.1%for ≥60 years or older.2.The assessment results of different screening tools were as follows.(1)SARC-F assessment tool showed a high risk of sarcopenia incidence of 10.9%and an area under the ROC curve of 0.699(95% CI: 0.627-0.764),when the cut-off point was taken as >0,at which time the Jorden index of 0.355 was the maximum,with a sensitivity of 62.90 and specificity of 72.58.(2)The SARC-Cal F assessment tool showed a high risk of sarcopenia of 33.9%,an area under the ROC curve of 0.771(95% CI: 0.704-0.829),a Jordans index of 0.435 at a cut-off point of >10,a sensitivity of 62.90 and a specificity of 80.65.(3)The SARC-F+EBM assessment tool showed a high risk of sarcopenia of 25.8%,an area under the ROC curve of 0.778(95% CI: 0.711-0.836),a maximum Jordans index of 0.443,a sensitivity of 91.94 and a specificity of 52.42 when the cut-off point was >1.(4)The Ishii assessment tool showed that the risk of hyperosmia was 43.0%,the area under the ROC curve for men was 0.907(95% CI: 0.828-0.957),and when the cut-off point was >100,the Jordans index was 0.747,the sensitivity was 96.55,the specificity was 78.12,and the area under the ROC curve for women was 0.804(95% CI:0.708-0.836).95% CI: 0.708-0.879),when the cut-off point is >118,the Jorden index0.505 is the maximum,the sensitivity is 78.79,and the specificity is 71.67.(5)The C-MSRA-5 assessment tool showed a high risk of sarcopenia of 47.8%,an area under the ROC curve of 0.640(95% CI: 0.567-0.709),and a maximum Jordans index of 0.250 with a sensitivity of 64.52 and specificity of 60.48 when the cut-off point was ≤45.(6)The C-MSRA-7 assessment tool showed a high risk of sarcopenia of 62.9%,an area under the ROC curve of 0.632(95% CI: 0.559-0.702),a Yordon index of 0.209 with a maximum sensitivity of 51.61 and a specificity of 69.35 when the cut-off point was≤25.3.In the comparison of different assessment tools in terms of veracity at each original cut-off point,the Ishii score for men showed a sensitivity of 89.6,a specificity of81.25,a Yordon index of 0.709,a positive likelihood ratio of 4.78 and a negative likelihood ratio of 0.13,which were better than other screening tools.Kappa value was0.654,positive predictive value was 68.4 and negative predictive value was 94.5,which was better than other screening tools;in the AUC comparison showed that Ishii score AUC was 0.856,which was greater than the AUC of other assessment tools.There was no statistical difference between the AUC of SARC-F score,C-MSRA-5scale and C-MSRA-7 scale;there was no statistical difference between the AUC of SARC-Cal F score and SARC-F + EBM score(P>0.05);All others were statistically different from each other(P < 0.05).4.Using the Mini Nutrition Questionnaire as a diagnostic criterion,58 cases(31.2%)of good nutrition,116 cases(62.4%)of potential malnutrition risk and 12 cases(6.4%)of definite malnutrition were obtained.The total SF-36 quality of life score for maintenance hemodialysis patients was(62.40 ± 14.29),with scores of(78.1 ± 23.11)for each dimension,(42.60 ± 24.30)for physical function,(87.63 ± 16.95)for somatic pain,(48.56 ± 16.21)for general health status,(69.89 ± 16.77),(64.85±25.11)for social functioning,(26.16±31.52)for emotional functioning,and(81.50±12.50)for mental health.5.Multifactorial results showed that age,results of mini-nutritional questionnaire assessment,marital status,willingness to go out socially and regular exercise were risk factors for quality of life.Conclusion: This study recommends the Ishii score as the preferred screening tool for sarcopenia in patients with MHD,followed by the SARC-Cal F score and SARC-F+EBM score,and optionally the SARC-F score,C-MSRA-7 scale and C-MSRA-5 scale in special cases.patients with MHD are generally at high risk of malnutrition and have a low level of quality of life.were at a lower level.Multifactorial analysis showed that age,MNA nutritional status,marital status,willingness to go out socially,and regular exercise were risk factors for quality of life. |
PDF Full Text Request