Rongrong Tian1, Liyang Chang1, Dan Liu1, Fenxia Luo1, Ying Zhang2, Linghong Cheng1, Hongmei Zhang1. 1. Department of Blood Purification Centre, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China. 2. The Department of Science and Development, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Abstract
BACKGROUND: In the updated consensus, low muscle strength overtook the role of low muscle mass, and probable sarcopenia was diagnosed once low muscle strength was detected. Whether the modified creatinine index (mCI) could identify persons with probable sarcopenia who may be at risk of adverse outcomes remains unknown. We aimed to evaluate the association of the mCI with probable sarcopenia and mortality in patients undergoing hemodialysis. METHODS: In the cross-sectional study (n = 346), univariate and multivariable logistic regression analyses were performed to study the association of mCI with probable sarcopenia. Modified Quantitative Subjective Global Assessment (MQSGA) was used to evaluate the nutritional status. The performance of the mCI value for identifying probable sarcopenia was analyzed using receiver operating characteristic (ROC) curve analysis. The appropriate cutoff points were determined using Youden's method. In the longitudinal cohort study composed of an independent hemodialysis cohort (n = 218), cox proportional regression models were used to evaluate crude and adjusted hazard ratios and 95% confidence intervals (CIs) of death by mCI and MQSGA. RESULTS: Cross-sectional results showed that after adjusting for confounders, the association of mCI with low muscle strength remained significant. The area under the curve (AUC) of the mCI to predict probable sarcopenia was 0.804 (95% CI, 0.744-0.863; p < 0.001) for men and 0.787 (95% CI, 0.711-0.864; p < 0.001) for women. The optimal mCI cutoff values were 21.07 mg/kg/d for men and 19.57 mg/kg/d for women, respectively. Longitudinal results showed that compared with those in the high mCI group, subjects in the low mCI group had a higher risk of death for all causes (adjusted HR, 2.51; 95% CI, 1.16-5.41; p = 0.019). Adding the mCI significantly improved the predictive accuracy for death with an increase in C-index from 0.785 to 0.805 (p = 0.026) and improved the net reclassification index (38.6%, p = 0.021), while adding MQSGA did not. CONCLUSION: The mCI is a predictor of muscle strength and survival in hemodialysis patients, and is preferable to the MQSGA for predicting death. Assessment of mCI could provide additional predictive and prognostic information to sarcopenia.
BACKGROUND: In the updated consensus, low muscle strength overtook the role of low muscle mass, and probable sarcopenia was diagnosed once low muscle strength was detected. Whether the modified creatinine index (mCI) could identify persons with probable sarcopenia who may be at risk of adverse outcomes remains unknown. We aimed to evaluate the association of the mCI with probable sarcopenia and mortality in patients undergoing hemodialysis. METHODS: In the cross-sectional study (n = 346), univariate and multivariable logistic regression analyses were performed to study the association of mCI with probable sarcopenia. Modified Quantitative Subjective Global Assessment (MQSGA) was used to evaluate the nutritional status. The performance of the mCI value for identifying probable sarcopenia was analyzed using receiver operating characteristic (ROC) curve analysis. The appropriate cutoff points were determined using Youden's method. In the longitudinal cohort study composed of an independent hemodialysis cohort (n = 218), cox proportional regression models were used to evaluate crude and adjusted hazard ratios and 95% confidence intervals (CIs) of death by mCI and MQSGA. RESULTS: Cross-sectional results showed that after adjusting for confounders, the association of mCI with low muscle strength remained significant. The area under the curve (AUC) of the mCI to predict probable sarcopenia was 0.804 (95% CI, 0.744-0.863; p < 0.001) for men and 0.787 (95% CI, 0.711-0.864; p < 0.001) for women. The optimal mCI cutoff values were 21.07 mg/kg/d for men and 19.57 mg/kg/d for women, respectively. Longitudinal results showed that compared with those in the high mCI group, subjects in the low mCI group had a higher risk of death for all causes (adjusted HR, 2.51; 95% CI, 1.16-5.41; p = 0.019). Adding the mCI significantly improved the predictive accuracy for death with an increase in C-index from 0.785 to 0.805 (p = 0.026) and improved the net reclassification index (38.6%, p = 0.021), while adding MQSGA did not. CONCLUSION: The mCI is a predictor of muscle strength and survival in hemodialysis patients, and is preferable to the MQSGA for predicting death. Assessment of mCI could provide additional predictive and prognostic information to sarcopenia.
Authors: Milou M Oosterwijk; Niala den Braber; Stephan J L Bakker; Gozewijn D Laverman Journal: J Cachexia Sarcopenia Muscle Date: 2022-02-27 Impact factor: 12.910
Authors: Matthew J Delmonico; Tamara B Harris; Marjolein Visser; Seok Won Park; Molly B Conroy; Pedro Velasquez-Mieyer; Robert Boudreau; Todd M Manini; Michael Nevitt; Anne B Newman; Bret H Goodpaster Journal: Am J Clin Nutr Date: 2009-10-28 Impact factor: 7.045