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Association of SARC-F Score and Rockwood Clinical Frailty Scale with CT-Derived Muscle Mass in Patients with Aortic Aneurysms



Patients with aortic aneurysms (AA) are often co-morbid and susceptible to frailty. Low core muscle mass has been used as a surrogate marker of sarcopenia and indicator of frailty. This study aimed to assess association between core muscle mass with sarcopenia screening tool SARC-F and Clinical Frailty Scale (CFS) in patients with AA.


Prospective audit of patients in pre-operative aortic clinic between 01/07/2019–31/01/2020 including frailty assessment using Rockwood CFS and sarcopenia screening using SARC-F questionnaire. Psoas and sartorius muscle area were measured on pre-operative CT scans and adjusted for height. Association was assessed using Spearman’s rank correlation coefficient.


Of 84 patients assessed, median age was 75 years [72,82], 84.5% were men, 65.5% were multimorbid and 63.1% had polypharmacy. Nineteen percent were identified as frail (CFS score >3) and 6.1% positively screened for sarcopenia (SARC-F score 4 or more).

Median psoas area (PMA) at L3 was 5.6cm2/m2 [4.8,6.6] and L4 was 7.4cm2/m2 [6.3,8.6]. Median sartorius area (SMA) was 1.8 cm2/m2 [1.5,2.2]. CFS demonstrated weak but statistically significant negative correlation with height-adjusted PMA at L3 (r=−0.25, p=0.034) but not at L4 (r=−0.23, p=0.051) or with SMA (r=−0.22, p=0.065). No association was observed between SARC-F score and PMA or SMA (L3 PMA r=−0.015, p=0.9; L4 PMA r=−0.0014, p= 0.99; SMA r=−0.051, p=0.67)


CFS showed higher association with CT-derived muscle mass than SARC-F. Comprehensive pre-operative risk-stratification tools which incorporate frailty assessment and body composition analysis may assist in decision making for surgery and allow opportunity for pre-habilitation.

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Funding: JML is supported by the NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Trust and University of Birmingham. The views expressed are those of the authors and not necessarily the Department of Health and Social Care.

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Correspondence to Kathryn Brown.

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Declaration of interest: None

Ethical standards: This prospective audit study was undertaken in a high-volume, quaternary referral aortic centre as part of a Trust-approved quality improvement project under the Specialised Clinical Frailty Network ( No intervention was performed, and patients were not contacted outside their routine clinical care. Therefore, specific ethical approval was not required and patient consent was not sought.

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Brown, K., Cheng, Y., Harley, S. et al. Association of SARC-F Score and Rockwood Clinical Frailty Scale with CT-Derived Muscle Mass in Patients with Aortic Aneurysms. J Nutr Health Aging 26, 792–798 (2022).

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Key words

  • Morphomics
  • sarcopenia
  • body-composition
  • frailty