Tesis

Performa Penapisan Instrumen Mini Sarcopenia Risk Assessment (MSRA) dan Instrumen MSRA-LB terhadap Diagnosis Sarkopenia pada Pasien Lanjut Usia = The Screening Performance of Mini Sarcopenia Risk Assessment (MSRA) and MSRA-CC Instruments to Diagnose Sarcopenia in Elderly Patients.

Latar Belakang: Sarkopenia merupakan sindroma klinik akibat penurunan massa dan kekuatan otot terkait usia yang menurunkan performa fisik. Prevalensi sarkopenia cukup tinggi secara global, regional ataupun nasional, dengan posisi tertinggi dalam sindroma geriatri baru. Sarkopenia menghasilkan luaran klinis yang buruk sehingga perlu dilakukan penapisan guna mencegah beban kesehatan. Instrumen standar penapisan saat ini memiliki sensitivitas yang rendah. Terdapat instrumen baru yaitu Mini Sarcopenia Risk Assessment (MSRA) dengan performa penapisan yang beragam. Untuk peningkatan performa MSRA dilakukan modifikasi dengan penambahan ukuran lingkar betis (LB) agar diperoleh instrumen yang sensitif. Tujuan: Mengetahui performa penapisan instrumen MSRA dan MSRA-LB terhadap diagnosis sarkopenia pada pasien lansia. Metode: Penelitian ini merupakan studi potong lintang pada pasien lansia unit rawat jalan Departemen Ilmu Penyakit Dalam RSCM, periode Oktober hingga Desember 2022. Data diambil melalui wawancara dan pemeriksaan fisik antropometri, pengukuran LB pengukuran kekuatan genggaman tangan (KGT), pengukuran indeks massa otot (IMO) apendikular, dan penilaian performa fisik dengan uji duduk berdiri lima kali. Hasil: Diperoleh subjek sebesar 118 pasien dengan proporsi sarkopenia sebesar 19 pasien (16,1%) berdasarkan AWGS 2019. Sensitivitas instrumen MSRA-7, MSRA-5, MSRA-7- LB dan MSRA-5-LB secara berurutan adalah 78,95%, 57,89%, 57,89% dan 42,11%. Sedangkan spesifisitas adalah 30,30%, 46,46%, 87,88% and 93,94%. Penambahan LB pada instrumen MSRA menjadi model MSRA-LB meningkatkan akurasi diagnosis secara bermakna p=0,003 pada MSRA-7-LB dan p= 0,005 pada MSRA-5-LB p=0,00. Simpulan: Performa penapisan intrumen MSRA memiliki sensitivitas tinggi pada versi 7 pertanyaan. Penambahan lingkar betis memperbaiki akurasi diagnosis instrumen MSRA namun tidak meningkatkan senstivitas instrumen.
Kata Kunci: Sarkopenia, MSRA, lingkar betis, AWGS, lanjut usia



Background: Sarcopenia is a clinical syndrome due to age-related decline in muscle mass and strength, which decline in physical performance. Globally, sarcopenia had high prevalence, also in regional and national. In new geriatric syndrome, it was the highest prevalence. Sarcopenia had unfavorable clinical outcomes, in order to prevent healt burden, it is needed to be detected through sensitive screening tools. Nowadays, standar tools for screening sarcopenia have low sensitivity. Mini Sarcopenia Risk Assessment (MSRA) was a new tool which had inconsistent screening performance. To increase performance of MSRA, we combined the MSRA with calf circumference (CC) measurements to find an instrument with good sensitivity and specificity values. Objective: To determine the screening performance of the MSRA and MSRA-LB instruments. Methods: This is a cross-sectional study of elderly outpatients in the Internal Medicine Department, Cipto Mangunkusumo Central General Hospital, from October to December 2022. Data were collected through interviews and anthropometric examinations, including measurements of body weight, hand grip strength, appendicular muscle mass index, and physical performance using the five times sit-to-stand test. Result: A total of 120 patients met the inclusion criteria, with 45 patients (37.5%) diagnosed with sarcopenia based on the 2019 AWGS criteria. The analysis data showed the sensitivity values of MSRA-7, MSRA-5, MSRA-7-CC, MSRA-5-CC were 78,95%, 57,89%, 57,89% and 42,11%, respectively. While the specificities were 30,30%, 46,46%, 87,88% and 93,94%, respectively. Combination MSRA-CC improved diagnostic accuracy with p value in MSRA-7-CC and MSRA-5-CC 0,003 and 0,005, respectively. Summary: The screening performance of MSRA has the high sensitivity in 7 item questions version. Combination MSRA-CC improved diagnostic accuracy of sarcopenia without increasing of sensitivity those instruments.
Keywords: Sarcopenia, MSRA, calf circumference, AWGS, elderly