{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T17:50:38Z","timestamp":1782409838878,"version":"3.54.5"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sociedade Brasileira de Reumatologia"},{"name":"Fundo de Incentivo \u00e0 Pesquisa e Eventos do Hospital de Cl\u00ednicas de Porto Alegre"},{"name":"Sociedade de Reumatologia do Rio Grande do Sul"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>In view of the method of diagnosing sarcopenia being complex and considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People (EWGSOP) recommends the use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice. Only recently, some studies have turned their attention to the presence of sarcopenia in systemic sclerosis (SSc).There is no data about performance of SARC-F and other screening tests for sarcopenia in this population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To compare the accuracy of SARC-F, SARC-CalF, SARC-F+EBM, and Ishii test as screening tools for sarcopenia in patients with SSc.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Cross-sectional study of 94 patients with SSc assessed by clinical and physical evaluation. Sarcopenia was defined according to the revised 2019 EWGSOP diagnostic criteria (EWGSOP2) with assessments of dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB). As case finding tools, SARC-F, SARC-CalF, SARC-F+EBM and Ishii test were applied, including data on calf circumference, body mass index, limitations in strength, walking ability, rising from a chair, stair climbing, and self reported number of falls in the last year. The screening tests were evaluated through receiver operating characteristic (ROC) curves. Standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Sarcopenia was identified in 15 (15.9%) patients with SSc by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.420\u20130.756, <jats:italic>p<\/jats:italic> = 0.283). The results of sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and diagnostic <jats:italic>Odds Ratio<\/jats:italic> (DOR) with the EWGSOP2 criteria as the gold standard were 40.0% (95% CI, 19.8\u201364.2), 81.0% (95% CI, 71.0\u201388.1), 2.11 (95% CI, 0.98\u20134.55), 0.74 (95% CI, 0.48\u20131.13) and 2.84 (95% CI, 0.88\u20139.22), respectively. SARC-CalF and SARC-F+EBM showed better sensitivity (53.3%, 95% CI 30.1\u201375.2 and 60.0%, 95% CI 35.7\u201380.2, respectively) and specificity (84.8%, 95% CI 75.3\u201391.1 and 86.1%, 95% CI 76.8\u201392.0, respectively) compared with SARC-F. The best sensitivity was obtained with the Ishii test (86.7%, 95% CI 62.1\u201396.3), at the expense of a small loss of specificity (73.4%, 95% CI 62.7\u201381.9). Comparing the ROC curves, SARC-F performed worse than SARC-CalF, SARC-F+EBM and Ishii test as a sarcopenia screening tool in this population (AUCs 0.588 vs. 0.718, 0.832, and 0.862, respectively). Direct comparisons between tests revealed differences only between SARC-F and Ishii test for sensitivity (<jats:italic>p<\/jats:italic> = 0.013) and AUC (<jats:italic>p<\/jats:italic> = 0.031).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>SARC-CalF, SARC-F+EBM, and Ishii test performed better than SARC-F alone as screening tools for sarcopenia in patients with SSc. Considering diagnostic accuracy and feasibility aspects, SARC-F+EBM seems to be the most suitable screening tool to be adopted in routine care of patients with SSc.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0245683","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T22:42:36Z","timestamp":1611355356000},"page":"e0245683","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Practical screening tools for sarcopenia in patients with systemic sclerosis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3240-7174","authenticated-orcid":true,"given":"Vanessa","family":"Hax","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafaela Cavalheiro","family":"do Esp\u00edrito Santo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Peterson","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirian","family":"Farinon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne Schrader","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Levi","family":"Tr\u00eas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrese Aline","family":"Gasparin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole Pamplona Bueno","family":"de Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Bredemeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Machado","family":"Xavier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Mendon\u00e7a da Silva","family":"Chakr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"issue":"5 Suppl","key":"pone.0245683.ref001","doi-asserted-by":"crossref","first-page":"990S","DOI":"10.1093\/jn\/127.5.990S","article-title":"Sarcopenia: origins and clinical relevance.","volume":"127","author":"IH Rosenberg","year":"1997","journal-title":"J Nutr"},{"issue":"1","key":"pone.0245683.ref002","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis.","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","journal-title":"Age Ageing."},{"issue":"8","key":"pone.0245683.ref003","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jamda.2013.05.018","article-title":"SARC-F: A simple questionnaire to rapidly diagnose sarcopenia.","volume":"14","author":"TK Malmstrom","year":"2013","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"pone.0245683.ref004","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/jcsm.12048","article-title":"SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes.","volume":"7","author":"TK Malmstrom","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"8","key":"pone.0245683.ref005","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1007\/s12603-019-1222-x","article-title":"SARC-F Validation and SARC-F+EBM Derivation in Musculoskeletal Disease: The SPSS-OK Study.","volume":"23","author":"N Kurita","year":"2019","journal-title":"J Nutr Heal Aging"},{"key":"pone.0245683.ref006","first-page":"1","article-title":"Screening Accuracy of SARC-F Combined With Calf Circumference forSarcopenia in Older Adults: A Diagnostic Meta-Analysis.","volume":"2018","author":"Y Mo","year":"2019","journal-title":"J Am Med Dir Assoc."},{"issue":"12","key":"pone.0245683.ref007","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.jamda.2016.08.004","article-title":"Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice.","volume":"17","author":"TG Barbosa-Silva","year":"2016","journal-title":"J Am Med Dir Assoc."},{"issue":"8","key":"pone.0245683.ref008","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1007\/s12603-018-1067-8","article-title":"Performance of SARC-F in Regard to Sarcopenia Definitions, Muscle Mass and Functional Measures","volume":"22","author":"G Bahat","year":"2018","journal-title":"J Nutr Heal Aging"},{"key":"pone.0245683.ref009","doi-asserted-by":"crossref","first-page":"71","DOI":"10.2147\/CLEP.S148638","article-title":"Comparison of the performance of five screening methods for sarcopenia.","volume":"10","author":"M Locquet","year":"2018","journal-title":"Clin Epidemiol."},{"issue":"8","key":"pone.0245683.ref010","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.jamda.2018.04.001","article-title":"SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy.","volume":"19","author":"S Ida","year":"2018","journal-title":"J Am Med Dir Assoc."},{"issue":"SUPPL.1","key":"pone.0245683.ref011","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/ggi.12197","article-title":"Development of a simple screening test for sarcopenia in older adults","volume":"14","author":"S Ishii","year":"2014","journal-title":"Geriatr Gerontol Int"},{"issue":"2","key":"pone.0245683.ref012","first-page":"202","article-title":"Scleroderma (systemic sclerosis): classification, subsets and pathogenesis.","volume":"15","author":"EC LeRoy","year":"1988","journal-title":"J Rheumatol"},{"issue":"10","key":"pone.0245683.ref013","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1007\/s00296-019-04401-w","article-title":"Sarcopenia in systemic sclerosis: the impact of nutritional, clinical, and laboratory features.","volume":"39","author":"C Corallo","year":"2019","journal-title":"Rheumatol Int"},{"issue":"4","key":"pone.0245683.ref014","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s10067-017-3932-y","article-title":"Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis.","volume":"37","author":"C Caimmi","year":"2018","journal-title":"Clin Rheumatol."},{"key":"pone.0245683.ref015","first-page":"55","article-title":"Prevalence of sarcopenia in systemic sclerosis: Assessing body composition and functional disability in patients with systemic sclerosis.","author":"E Siegert","year":"2018","journal-title":"Nutrition"},{"issue":"7","key":"pone.0245683.ref016","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1007\/s10067-013-2235-1","article-title":"Risk factors for body composition abnormalities in systemic sclerosis.","volume":"32","author":"TF Marighela","year":"2013","journal-title":"Clin Rheumatol"},{"issue":"4","key":"pone.0245683.ref017","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1177\/0148607115597883","article-title":"Medical Nutrition Therapy for Patients With Advanced Systemic Sclerosis (MNT PASS): A pilot intervention study.","volume":"41","author":"B Doerfler","year":"2017","journal-title":"J Parenter Enter Nutr."},{"issue":"16","key":"pone.0245683.ref018","doi-asserted-by":"crossref","first-page":"5678","DOI":"10.3390\/ijms21165678","article-title":"Sarcopenia in Autoimmune and Rheumatic Diseases: A Comprehensive Review.","volume":"21","author":"HJ An","year":"2020","journal-title":"Int. J. Mol. Sci"},{"issue":"12","key":"pone.0245683.ref019","doi-asserted-by":"crossref","first-page":"504","DOI":"10.3390\/jcm7120504","article-title":"Sarcopenia in Patients with Rheumatic Diseases: Prevalence and Associated Risk Factors.","volume":"7","author":"M Barone","year":"2018","journal-title":"J Clin Med."},{"issue":"10","key":"pone.0245683.ref020","first-page":"YE01","article-title":"Requirements for minimum sample size for sensitivity and specificity analysis.","volume":"10","author":"MA Bujang","year":"2016","journal-title":"J Clin Diagnostic Res."},{"issue":"7","key":"pone.0245683.ref021","first-page":"1281","article-title":"Inter and intraobserver variability of total skin thickness score (modified Rodnan TSS) in systemic sclerosis.","volume":"22","author":"P Clements","year":"1995","journal-title":"J Rheumatol"},{"issue":"11","key":"pone.0245683.ref022","doi-asserted-by":"crossref","first-page":"2737","DOI":"10.1002\/art.38098","article-title":"2013 Classification Criteria for Systemic Sclerosis: An American College of Rheumatology\/European League Against Rheumatism Collaborative Initiative","volume":"65","author":"F van den Hoogen","year":"2013","journal-title":"Arthritis Rheum"},{"key":"pone.0245683.ref023","first-page":"1573","article-title":"Criteria for the classification of early systemic sclerosis.","volume":"28","author":"EC LeRoy","year":"2001","journal-title":"Journal of Rheumatology"},{"key":"pone.0245683.ref024","author":"T Lohman","year":"1988","journal-title":"Anthropometrics standartization reference manual"},{"issue":"4","key":"pone.0245683.ref025","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach.","volume":"40","author":"HC Roberts","year":"2011","journal-title":"Age Ageing."},{"issue":"2","key":"pone.0245683.ref026","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"JM Guralnik","year":"1994","journal-title":"J Gerontol"},{"issue":"4","key":"pone.0245683.ref027","first-page":"203","article-title":"Measures of Diagnostic Accuracy: Basic Definitions.","volume":"19","author":"AM Simundic","year":"2009","journal-title":"Ejifcc"},{"key":"pone.0245683.ref028","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1002\/jcsm.12049","article-title":"Prevalence of sarcopenia among community-dwelling elderly of a medium-sized South American city: Results of the COMO VAI? study.","volume":"7","author":"TG Barbosa-Silva","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"1","key":"pone.0245683.ref029","first-page":"1","article-title":"A sarcopenia screening test predicts mortality in hospitalized older adults.","volume":"8","author":"T Tang","year":"2018","journal-title":"Sci Rep"},{"issue":"9","key":"pone.0245683.ref030","first-page":"1","article-title":"Accuracy and prognostic ability of the SARC-F questionnaire and ishii\u2019s score in the screening of sarcopenia in geriatric inpatients.","volume":"52","author":"M Li","year":"2019","journal-title":"Brazilian J Med Biol Res"},{"issue":"3","key":"pone.0245683.ref031","doi-asserted-by":"crossref","first-page":"277.e1","DOI":"10.1016\/j.jamda.2017.12.016","article-title":"Screening Sarcopenia in Community-Dwelling Older Adults: SARC-F vs SARC-F Combined With Calf Circumference (SARC-CalF).","volume":"19","author":"M Yang","year":"2018","journal-title":"J Am Med Dir Assoc."},{"issue":"10","key":"pone.0245683.ref032","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s40520-018-1083-x","article-title":"Comparison of four sarcopenia screening tools in nursing home residents.","volume":"31","author":"M Yang","year":"2019","journal-title":"Aging Clin Exp Res"},{"issue":"9","key":"pone.0245683.ref033","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1007\/s12603-018-1072-y","article-title":"Comparing SARC-F with SARC-CalF to screen sarcopenia in community living older adults","volume":"22","author":"G Bahat","year":"2018","journal-title":"J Nutr Heal Aging"},{"issue":"1","key":"pone.0245683.ref034","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/s12877-016-0349-4","article-title":"Sarcopenia in daily practice: assessment and management.","volume":"16","author":"C Beaudart","year":"2016","journal-title":"BMC Geriatr"},{"issue":"3","key":"pone.0245683.ref035","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s12603-013-0410-3","article-title":"A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people","volume":"18","author":"L Cao","year":"2014","journal-title":"J Nutr Heal Aging"},{"issue":"12","key":"pone.0245683.ref036","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.jamda.2016.07.029","article-title":"Sarcopenia Screened With SARC-F Questionnaire Is Associated With Quality of Life and 4-Year Mortality.","volume":"17","author":"TY Wu","year":"2016","journal-title":"J Am Med Dir Assoc"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245683","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T22:43:02Z","timestamp":1611355382000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245683"}},"subtitle":[],"editor":[{"given":"Joao Felipe","family":"Mota","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0245683","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,22]]}}}