Poor performance of strength, assistance with walking, rising from a chair, climbing stairs and falls for sarcopenia screening in cirrhosis: A pilot study

Abstract

BACKGROUND

Hepatic cirrhosis is a chronic condition often associated with malnutrition and sarcopenia, both of which negatively affect patient prognosis. Early identification of sarcopenia is essential for effective interventions.

AIM

To evaluate the strength, assistance with walking, rising from a chair, climbing stairs and falls (SARC-F) questionnaire as an indirect predictor of sarcopenia risk in patients with chronic liver disease (CLD).

METHODS

This was a pilot, prospective, cross-sectional study including 45 patients with hepatic cirrhosis undergoing clinical follow-up at the Gastroenterology Outpatient Clinic of the Hospital Complex of the Irmandade Santa Casa de Misericórdia de Porto Alegre. The following tools were used: Phase angle, five times sit-to-stand test, handgrip strength (HGS), and the SARC-F questionnaire.

RESULTS

Among the 45 patients evaluated (mean age: 61 years, slight male predominance), the SARC-F questionnaire identified only eight suspected cases of sarcopenia. In contrast, objective strength tests identified 15 cases by HGS and 21 by the sit-to-stand test. Cross-tabulation analysis showed that SARC-F did not identify any true positives and demonstrated low specificity and negative predictive value, compromising its effectiveness as a screening tool.

CONCLUSION

Despite its ease of application and low cost, the SARC-F demonstrated limited sensitivity and a high rate of false-positive results, compromising its accuracy as a standalone screening tool for sarcopenia in patients with hepatic cirrhosis.

Keywords: Liver cirrhosis; Sarcopenia; Nutritional status; Screening instruments; Hand strength

Core Tip: Sarcopenia is common in cirrhosis and negatively affects prognosis. Early detection is essential for effective management. We evaluated the strength, assistance with walking, rising from a chair, climbing stairs and falls (SARC-F) questionnaire as a screening tool in 45 cirrhotic patients. We compared its performance with objective functional tests, including handgrip strength and the five times sit-to-stand test. Our main finding is that SARC-F significantly underperformed, missing all true positive cases and showing low sensitivity. In contrast, functional tests detected more patients at risk and proved more reliable. This indicates that SARC-F should not be used alone in cirrhotic patients. Functional assessments provide better guidance and should be integrated into clinical screening protocols.