SARC-F Score: A Quick Bedside Tool to Screen Sarcopenia in Patients With Cirrhosis

Abstract

Aim

Sarcopenia is often ignored in clinical practice despite being an important prognostic marker. SARC-F is a simple bedside score to assess muscle abnormalities in cirrhosis patients. However, there is limited Indian data on the validity of this score. Hence, we aimed to assess the validity of SARC-F score in a tertiary care center.

Methods

A prospective observational study including consecutive 100 cirrhosis patients attending the Gastroenterology outpatient department in Osmania Medical College & Hospital, Hyderabad, India was conducted from Jan 2018 to Dec 2019. The primary aim was to assess the mean muscle volume loss (MVL) by computed tomography and handgrip (HG) strength for muscle strength decline (MSD) and compare the SARC-F score with standard cut-off values.

Results

We included 100 cirrhosis patients (mean age 45 years; males-86%; child-pugh class B/C: 42/58). 69% of the patients had a SARC-F score≥4, while MVL & MSD were noted in 62% and 86% patients respectively. Mid-arm circumference, skin fold thickness, mid-arm muscle circumference (MAMC) and HG strength were significantly lower in patients with SARC-F≥4 than those with SARC-F<4 (p<0.05). The Pearson correlation plot suggested significant inverse correlation between SARC-F score & MSD and SARC-F score & MVL. SARC-F score≥4 had a sensitivity and specificity of 80.7% & 50% for MVL and 75.6% & 71.4% for MSD respectively, while it was 83.3% & 52.5% for MSD and MVL combined respectively. Area under the receiver operating characteristic curve for SARC-F as a predictor of MVL was 0.75 (95% confidence interval, 0.64-0.82; p=<0.001). On multivariate analysis, a high SARC-F score and low MAMC were predictive of MVL in cirrhosis patients.

Conclusion

SARC-F score has good sensitivity as a bedside screening tool for sarcopenia in patients with cirrhosis. High SARC-F score and low MAMC indicates the presence of MVL and warrants further evaluation for sarcopenia.