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

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

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.

Methods

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.

Results

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)

Conclusion

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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References

  1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. doi:https://doi.org/10.1093/ageing/afy169

    Article  Google Scholar 

  2. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–423. doi:https://doi.org/10.1093/ageing/afq034

    Article  Google Scholar 

  3. Cruz-Jentoft AJ, Landi F, Topinková E, Michel JP. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010;13(1):1–7. doi:https://doi.org/10.1097/MCO.0b013e328333c1c1

    Article  Google Scholar 

  4. Landi F, Cruz-Jentoft AJ, Liperoti R, et al. Sarcopenia and mortality risk in frail olderpersons aged 80 years and older: Results from iLSIRENTE study. Age Ageing. 2013;42(2):203–209. doi:https://doi.org/10.1093/ageing/afs194

    Article  Google Scholar 

  5. Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7(1):28–36. doi:https://doi.org/10.1002/jcsm.12048

    Article  Google Scholar 

  6. Antunes AC, Araújo DA, Veríssimo MT, Amaral TF. Sarcopenia and hospitalisation costs in older adults: a cross-sectional study. Nutr Diet. 2017;74(1):46–50. doi:https://doi.org/10.1111/1747-0080.12287

    Article  Google Scholar 

  7. Cao L, Morley JE. Sarcopenia Is Recognized as an Independent Condition by an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) Code. J Am Med Dir Assoc. 2016;17(8):675–677. doi:https://doi.org/10.1016/j.jamda.2016.06.001

    Article  Google Scholar 

  8. Hajaoui M, Locquet M, Beaudart C, Reginster J-Y. Sarcopenia: Performance of the SARC-F Questionnaire According to the European Consensus Criteria, EWGSOP1 and EWGSOP2 Sarcopaenia-SarQol Romania View project Evidence on Health and Long Term Care Systems for Ageing Populations View project. Artic J Am Med Dir Assoc. Published online 2019. doi:https://doi.org/10.1016/j.jamda.2019.05.021

  9. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. In: The Lancet. Vol 381. Lancet Publishing Group; 2013:752–762. doi:https://doi.org/10.1016/S0140-6736(12)62167-9

  10. Ritt M, Schwarz C, Kronawitter V, et al. Analysis of Rockwood et al’s Clinical Frailty Scale and Fried et al’s frailty phenotype as predictors of mortality and other clinical outcomes in older patients who were admitted to a geriatric ward. J Nutr Heal Aging. 2015;19(10):1043–1048. doi:https://doi.org/10.1007/s12603-015-0667-9

    Article  CAS  Google Scholar 

  11. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–495. doi:https://doi.org/10.1503/cmaj.050051

    Article  Google Scholar 

  12. Mourtzakis M, Prado CMM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997–1006. doi:https://doi.org/10.1139/H08-075

    Article  Google Scholar 

  13. Antoniou GA, Rojoa D, Antoniou SA, Alfahad A, Torella F, Juszczak MT. Effect of Low Skeletal Muscle Mass on Post-operative Survival of Patients With Abdominal Aortic Aneurysm: A Prognostic Factor Review and Meta-Analysis of Time-to-Event Data. Eur J Vasc Endovasc Surg. 2019;58(2):190–198. doi:https://doi.org/10.1016/j.ejvs.2019.03.020

    Article  Google Scholar 

  14. Juszczak MT, Taib B, Rai J, et al. Total psoas area predicts medium-term mortality after lower limb revascularization. J Vasc Surg. 2018;68(4):1114–1125.e1. doi:https://doi.org/10.1016/j.jvs.2018.01.040

    Article  Google Scholar 

  15. Mok M, Allende R, Leipsic J, et al. Prognostic Value of Fat Mass and Skeletal Muscle Mass Determined by Computed Tomography in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol. 2016;117(5):828–833. doi:https://doi.org/10.1016/j.amjcard.2015.12.015

    Article  Google Scholar 

  16. Lee JSJ, He K, Harbaugh CM, et al. Frailty, core muscle size, and mortality in patients undergoing open abdominal aortic aneurysm repair. J Vasc Surg. 2011;53(4):912–917. doi:https://doi.org/10.1016/j.jvs.2010.10.111

    Article  Google Scholar 

  17. Cornuz J, Pinto CS, Tevaearai H, Egger M. Risk factors for asymptomatic abdominal aortic aneurysm: Sytematic review and meta-analysis of population-based screening studies. Eur J Public Health. 2004;14(4):343–349. doi:https://doi.org/10.1093/eurpub/14.4.343

    Article  Google Scholar 

  18. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972;1(4):233–238. doi:https://doi.org/10.1093/AGEING/1.4.233

    Article  CAS  Google Scholar 

  19. Derstine BA, Holcombe SA, Goulson RL, et al. Quantifying Sarcopenia Reference Values Using Lumbar and Thoracic Muscle Areas in a Healthy Population. J Nutr Health Aging. 2017;21(10):180–185. doi:https://doi.org/10.1007/s12603-017-0983-3

    CAS  PubMed  Google Scholar 

  20. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc. 2012;60(8):1487–1492. doi:https://doi.org/10.1111/j.1532-5415.2012.04054.x

    Article  Google Scholar 

  21. Fried LP, Tangen CM, Walston J, et al. Frailty in Older Adults: Evidence for a Phenotype. Journals Gerontol Ser A Biol Sci Med Sci. 2001;56(3):M146–M157. doi:https://doi.org/10.1093/gerona/56.3.m146

    Article  CAS  Google Scholar 

  22. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K. Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr. 2002;2:1–8. doi:https://doi.org/10.1186/1471-2318-2-1

    Article  Google Scholar 

  23. Arya S, Kim SI, Duwayri Y, et al. Frailty increases the risk of 30-day mortality, morbidity, and failure to rescue after elective abdominal aortic aneurysm repair independent of age and comorbidities. J Vasc Surg. 2015;61(2):324–331. doi:https://doi.org/10.1016/j.jvs.2014.08.115

    Article  Google Scholar 

  24. Juszczak MT, Murray A, Koutsoumpelis A, et al. Elective Fenestrated and Branched Endovascular Thoraco-abdominal Aortic Repair with Supracoeliac Sealing Zones and without Prophylactic Cerebrospinal Fluid Drainage: Early and Medium-term Outcomes. Eur J Vasc Endovasc Surg. 2019;57(5):639–648. doi:https://doi.org/10.1016/j.ejvs.2018.12.012

    Article  Google Scholar 

  25. Ida S, Kaneko R, Murata K. SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy. J Am Med Dir Assoc. 2018;19(8):685–689. doi:https://doi.org/10.1016/j.jamda.2018.04.001

    Article  Google Scholar 

  26. Woo J, Leung J, Morley JE. Validating the SARC-F: A suitable community screening tool for sarcopenia? J Am Med Dir Assoc. 2014;15(9):630–634. doi:https://doi.org/10.1016/j.jamda.2014.04.021

    Article  Google Scholar 

  27. Morley J. Developing Novel Therapeutic Approaches to Frailty. Curr Pharm Des. 2009;15(29):3384–3395. doi:https://doi.org/10.2174/138161209789105045

    Article  CAS  Google Scholar 

  28. Morley JE, Vellas B, Abellan van Kan G, et al. Frailty consensus: A call to action. J Am Med Dir Assoc. 2013;14(6):392–397. doi:https://doi.org/10.1016/j.jamda.2013.03.022

    Article  Google Scholar 

  29. Chen Z, Wang ZM, Lohman T, et al. Dual-energy X-ray absorptiometry is a valid tool for assessing skeletal muscle mass in older women. J Nutr. 2007;137(12):2775–2780. doi:https://doi.org/10.1093/jn/137.12.2775

    Article  CAS  Google Scholar 

  30. Ticinesi A, Meschi T, Narici M V., Lauretani F, Maggio M. Muscle Ultrasound and Sarcopenia in Older Individuals: A Clinical Perspective. J Am Med Dir Assoc. 2017;18(4):290–300. doi:https://doi.org/10.1016/j.jamda.2016.11.013

    Article  Google Scholar 

  31. Ambler GK, Brooks DE, Zuhir N Al, et al. Effect of frailty on short- and mid-term outcomes in vascular surgical patients. Br J Surg. 2015;102(6):638–645. doi:https://doi.org/10.1002/BJS.9785

    Article  CAS  Google Scholar 

  32. Srinivasan A, Ambler GK, Hayes PD, et al. Premorbid function, comorbidity, and frailty predict outcomes after ruptured abdominal aortic aneurysm repair. J Vasc Surg. 2016;63(3):603–609. doi:https://doi.org/10.1016/j.jvs.2015.09.002

    Article  Google Scholar 

  33. Al Shakarchi J, Fairhead J, Rajagopalan S, Pherwani A, Jaipersad A. Impact of Frailty on Outcomes in Patients Undergoing Open Abdominal Aortic Aneurysm Repair. Ann Vasc Surg. 2020;67:100–104. doi:https://doi.org/10.1016/j.avsg.2019.11.017

    Article  Google Scholar 

  34. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 2012 1076. 2012;107(6):931–936. doi:https://doi.org/10.1038/bjc.2012.350

    CAS  Google Scholar 

  35. Wagner D, DeMarco MM, Amini N, et al. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg. 2016;8(1):27. doi:https://doi.org/10.4240/WJGS.V8.I1.27

    Article  Google Scholar 

  36. Hasselager R, Gögenur I. Core muscle size assessed by perioperative abdominal CT scan is related to mortality, postoperative complications, and hospitalization after major abdominal surgery: a systematic review. Langenbeck’s Arch Surg 2014 3993. 2014;399(3):287–295. doi:https://doi.org/10.1007/S00423-014-1174-X

    Article  Google Scholar 

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Funding

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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Authors and Affiliations

  1. Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

    Kathryn Brown, Y. Cheng, S. Harley, C. Allen, M. Claridge, D. Adam, H. Nasr & M. Juszczak

  2. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Y. Cheng & M. Juszczak

  3. MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK

    J. M. Lord

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  1. Kathryn Brown
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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 (https://www.scfn.org.uk). 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). https://doi.org/10.1007/s12603-022-1828-2

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