SARC-CalF tool has no significant prognostic value in hospitalized patients: A prospective cohort study.

BACKGROUND: Screening of sarcopenia is proposed to identify patients who require the diagnosis of this condition. One of the proposed screening tools is Strength, Assistance with walking, Rise from a chair, Climb stairs, Fall and Calf Circumference (SARC-CalF). However, evidence for its applicability, especially in a hospital setting, is scarce. Therefore, this study aimed to evaluate the association between "suggestive signs of sarcopenia using SARC-CalF" and clinical outcomes. METHODS: Prospective cohort study with hospitalized patients aged ≥60 years was conducted, and they were evaluated within 48 h of admission using the SARC-CalF tool. Calf circumference and handgrip strength were measured, and the "timed get up and go" test was performed in all patients. The outcomes for testing the predictive validity of SARC-CalF were prolonged length of hospital stay, in-hospital death, hospital readmission, and mortality in 6 months. RESULTS: Of the 554 patients (55.22 ± 14.91 years old, 52.9% males) evaluated, 17.3% were classified as having "suggestive signs of sarcopenia using SARC-CalF." In univariate analysis, "suggestive signs of sarcopenia using SARC-CalF" was associated with in-hospital death (P = .002) and mortality in 6 months (P = .004). However, in the multivariate analysis, these associations were not significant. CONCLUSION: SARC-CalF was not an independent predictor of clinical outcomes during the hospitalization neither in the following 6 months of discharge.

Accuracy of three tools for malnutrition diagnosis in hospitalised patients: Comparison to subjective global assessment.

BACKGROUND: Malnutrition is prevalent in hospital, and the Subjective Global Assessment (SGA) has been widely used for its identification. However, in the last decade, new tools were proposed by the Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM). The diagnostic test accuracy of these tools has been scarcely investigated. Thus, we aimed to compare the accuracy of AND-ASPEN, ESPEN and GLIM for malnutrition diagnosis in hospitalised patients. METHODS: A cross-sectional study was conducted with hospitalised patients aged ≥ 18 years from a five-unit complex hospital. Malnutrition was diagnosed within 48 h of admission using SGA, AND-ASPEN, ESPEN and GLIM. The accuracy of these tools was evaluated by the area under the receiver operating characteristic (AUROC) curve, considering SGA as reference, which was compared by the DeLong test. RESULTS: Six hundred patients (55.7 ± 14.8 years, 51.3% male) were evaluated. AND-ASPEN [AUROC 0.846; 95% confidence interval (CI) = 0.810-0.883] and GLIM presented a satisfactory accuracy (AUROC 0.842; 95% CI, 0.807-0.877), whereas ESPEN had a substantially lower accuracy (AUROC, 0.572; 95% CI, 0.522-0.622). The AUROC of AND-ASPEN and GLIM were not different from each other (p = 0.785) and both had significantly higher accuracy than ESPEN (p < 0.001). AND-ASPEN and GLIM presented sensitivity, specificity and negative predictive value > 80%, whereas ESPEN sensitivity was < 20%. CONCLUSIONS: AND-ASPEN and GLIM were accurate methods for diagnosing malnutrition and could be applied in hospitalised patients. By contrast, the ESPEN criteria had unsatisfactory accuracy.

GLIM criteria for malnutrition diagnosis of hospitalized patients presents satisfactory criterion validity: A prospective cohort study.

BACKGROUND & AIMS: Malnutrition is prevalent among hospitalized patients, but there is no universally accepted consensus regarding its diagnosis. Recently, the Global Leadership Initiative on Malnutrition (GLIM) proposed a new framework for the malnutrition diagnosis and until this moment there is scarce evidence regarding its validity. This study aimed to evaluate the concurrent and predictive validity of GLIM criteria for malnutrition diagnosis in hospitalized patients. METHODS: Prospective cohort study involving adult/elderly hospitalized patients. The malnutrition diagnoses according to Subjective Global Assessment (SGA) and GLIM criteria were performed within 48 h of admission. Patients were followed up until hospital discharge to assess the length of hospital stay (LOS) and in-hospital mortality. Six months post discharge; the patients were contacted to collect the outcomes readmission and death. Agreement and accuracy tests, Cox and Logistic regression analysis were performed for testing criterion validity. RESULTS: 601 patients (55.7 ± 14.8 years, 51.3% men) were evaluated. Malnutrition was diagnosed in 33.9% and 41.6% of patients, by SGA and GLIM criteria, respectively. GLIM criteria presented a satisfactory accuracy, (AUC = 0.842; CI95% 0.807-0.877) with a sensitivity of 86.6%, and a specificity of 81.6%. The presence of malnutrition by GLIM criteria increased the chance of prolonged hospitalization by 1.76 (CI95% 1.23-2.52) times, and the risk of in-hospital deaths by 5.1 (CI95% 1.14-23.14) times. It was also associated with death within six months (RR = 3.96, CI95% 1.49-10.53). CONCLUSION: GLIM criteria for malnutrition diagnosis presented satisfactory criterion validity and should be applied during clinical practice.