Correlation between sarcopenia index and severity of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Min ^1,3 ,  HOU Tianqiang ¹ ,  JIANG Qianfeng ²

1. Tongren People's Hospital, Tongren, Guizhou 554300, P. R. China;
2. Zunyi First People's Hospital, Zunyi, Guizhou 563000, P. R. China;
3. Xianning Maternal and Child Health Hospital, Xianning, Hubei 437000, P. R. China;

Corresponding author：

HOU Tianqiang, Email: 371004458@qq.com; JIANG Qianfeng, Email: jiangqianfeng2005@126.com

Keywords：

Chronic obstructive pulmonary disease; creatinine; cystatin C; sarcopenia index; pulmonary function

DOI：

10.7507/1671-6205.202504010

Video：

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Objective To analyze the correlation between the sarcopenia index (the ratio of creatinine to cystatin C, CCR) and the severity of chronic obstructive pulmonary disease (COPD), and evaluate its potential value as an indicator for auxiliary diagnosis of COPD and assessment of disease severity. Methods A total of 315 patients who underwent pulmonary function tests at Tongren People's Hospital from January 2022 to December 2022 were selected. Among them, 180 patients were diagnosed with COPD, and 135 patients were non-COPD. The COPD group was further divided into GOLD1 group (mild, n=36), GOLD2 group (moderate, n=70), and GOLD3 group (severe, n=74) according to Chronic Obstructive Lung Disease (GOLD) classification. The clinical data, laboratory indicators, and pulmonary function test results of the patients were collected. Correlation analysis was used to explore the correlation between CCR and clinical data. Binary logistic regression analysis was used to explore the influencing factors of COPD. A receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated to evaluate the predictive value of CCR for COPD. Results Among the 315 enrolled patients, the prevalence of COPD was 57.14% (180/315). The CCR level of the COPD patients was significantly lower than that of the non-COPD patients. The more severe the condition of COPD patients, the lower the CCR value. The results of Spearman correlation analysis showed that CCR was significantly positively correlated with diffusion capacity of the lung for carbon monoxide, forced expiratory volume in the first second (FEV₁) as a percentage of predicted value, FEV₁/forced vital capacity, albumin, eosinophils, endogenous creatinine clearance rate, low-density lipoprotein cholesterol, and haemoglobin, and significantly negatively correlated with C-reactive protein, D-dimer, age, and neutrophil to lymphocyte ratio (all P<0.05). Binary logistic regression showed that after adjusting for other relevant factors, CCR was found to be an independent risk factor for the occurrence of COPD (OR=0.902, 95%CI 0.879 - 0.925, P<0.05). When the CCR value was 77.450, the AUC was 0.841 (95%CI 0.798 - 0.885), with a sensitivity of 60.7% and a specificity of 96.1%.Conclusion CCR is closely related to the disease condition and its severity in patients with stable-phase COPD, and it is an independent influencing factor for the occurrence of COPD.

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8.	Jones SE, Maddocks M, Kon SSC, et al. Sarcopenia in COPD: Prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax, 2015, 70(3): 213-218.
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10.	Chen LK, Woo J, Assantachai P, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307,e2.
11.	Kashani KB, Frazee EN, Kukrálová L, et al. Evaluating muscle mass by using markers of kidney function: development of the sarcopenia index. Crit Care Med, 2017, 45(1): e23-e29.
12.	Tan L, Li R, Hu X, et al. Serum creatinine/cystatin C ratio as a case-finding tool for low handgrip strength in Chinese middle-aged and older adults. Sci Rep, 2020, 10(1): 14028.
13.	Jenkins AR, Gaynor-Sodeifi K, Lewthwaite H, et al. Efficacy of interventions to alter measures of fat-free mass in people with COPD: a systematic review and meta-analysis. ERJ Open Res, 2023, 9(4): 102-2023.
14.	Chai L, Feng W, Zhai C, et al. The association between cystatin C and COPD: a meta-analysis and systematic review. BMC Pulm Med, 2020, 20(1): 182.
15.	Jung CY, Joo YS, Kim HW, et al. Creatinine-cystatin C ratio and mortality in patients receiving intensive care and continuous kidney replacement therapy: a retrospective cohort study. Am J Kidney Dis, 2021, 77(4): 509-516.
16.	Barreto EF, Poyant JO, Coville HH, et al. Validation of the sarcopenia index to assess muscle mass in the critically ill: a novel application of kidney function markers. Clin Nutr, 2019, 38(3): 1362-1367.
17.	Fu X, Tian Z, Wen S, et al. A new index based on serum creatinine and cystatin C is useful for assessing sarcopenia in patients with advanced cancer. Nutrition, 2021, 82: 111032.
18.	Osaka T, Hamaguchi M, Hashimoto Y, et al. Decreased the creatinine to cystatin C ratio is a surrogate marker of sarcopenia in patients with type 2 diabetes. Diabetes Res Clin Pract, 2018, 139: 52-58.
19.	Tang T, Zhuo Y, Xie L, et al. Sarcopenia index based on serum creatinine and cystatin C is associated with 3-year mortality in hospitalized older patients. Sci Rep, 2020, 10: 1260.
20.	Lee HS, Park KW, Kang J, et al. Sarcopenia index as a predictor of clinical outcomes in older patients with coronary artery disease. J Clin Med, 2020, 9(10): 3121.
21.	Komorita Y, Iwase M, Fujii H, et al. The serum creatinine to cystatin C ratio predicts bone fracture in patients with type 2 diabetes: The Fukuoka Diabetes Registry. Diabetes Res Clin Pract, 2018, 146: 202-210.
22.	Wang K, Jia S, Zhao W, et al. The creatinine-to-cystatin C ratio (a surrogate marker of muscle mass) as a predictor of lung function decline in older adults: A nationwide longitudinal study in China. Respir Med, 2023, 211: 107197.
23.	Lin YL, Chang IC, Liou HH, et al. Serum indices based on creatinine and cystatin C predict mortality in patients with nondialysis chronic kidney disease. Sci Rep, 2021, 11(1): 16863.
24.	Benz E, Trajanoska K, Lahoeuse L, et al. Sarcopenia in COPD: a systematic review and meta-analysis. Eur Respir Rev, 2019, 28(154): 190049.
25.	Huang D, Xie C, Sun C, et al. Serum creatinine to cystatin C ratio is an effective indicator for muscle strength decline in men with acute exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2022, 17: 781-789.
26.	Ma K, Huang F, Qiao R, et al. Pathogenesis of sarcopenia in chronic obstructive pulmonary disease. Front Physiol, 2022, 13: 850964.
27.	Hirai K, Tanaka A, Homma T, et al. Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with chronic obstructive pulmonary disease. Clin Nutr, 2021, 40(3): 1274-1280.
28.	Stevens LA, Schmid CH, Greene T, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int, 2009, 75(6): 652-660.
29.	Li J, Sun Q, Zhang H, et al. Serum-creatinine-to-cystatin C-to-waist-circumference ratios as an indicator of severe airflow limitation in older adults. J Clin Med, 2023, 12(22): 7116.
30.	Zhang M, Li Y, Yang X, et al. Serum cystatin C as an inflammatory marker in exacerbated and convalescent COPD patients. Inflammation, 2016, 39: 625-631.
31.	焦彬, 丁岩冰, 梁兰玉, 等. 血肌酐与胱抑素 C 的比值在溃疡性结肠炎合并骨骼肌质量减少中的意义. 现代消化及介入诊疗, 2022, 27: 1392-1396.
32.	Nishiki K, Nojiri M, Kato R, et al. Serum creatinine/cystatin C ratio associated with cross-sectional area of erector spinae muscles and pulmonary function in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3513-3524.
33.	Chen Z, Zha L, Ma X, et al. Serum creatinine/cystatin C ratio as a predictor of in-hospital mortality in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Lung, 2022, 200(5): 609-617.
34.	Qiu S, Cai X, Yuan Y, et al. Changes in creatinine-to-cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: the China health and retirement longitudinal study. J Diabetes, 2021, 13(12): 1025-1033.
35.	中国高血压防治指南修订委员会. 中国高血压防治指南 (2024 年修订版). 中华高血压杂志, 2024, 32(7): 603-700.

1. Global initiative for chronic obstructive lung disease. Global strategy for prevention, Diagnosis and management of COPD: 2024 Report[EB/OL]. [2025-07-10]. https://goldcopd.org/2024-gold-report/.
2. Adeloye D, Song P, Zhu Y, et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med, 2022, 10(5): 447-458.
3. Boers E, Barrett M, Su JG, et al. Global burden of chronic obstructive pulmonary disease through 2050. JAMA network open, 2023, 6(12): e2346598.
4. World Health Organization. Mortality and global health estimates[EB/OL]. [2025-02-15]. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates.
5. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis, 2014, 9: 871-888.
6. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J, 2009, 33(5): 1165-1185.
7. Demircioğlu H, , Cihan FG, Kutlu R, et al. Frequency of sarcopenia and associated outcomes in patients with chronic obstructive pulmonary disease. Turk J Med Sci, 2020, 50(5): 1270-1279.
8. Jones SE, Maddocks M, Kon SSC, et al. Sarcopenia in COPD: Prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax, 2015, 70(3): 213-218.
9. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised european consensus on definition and diagnosis. Age and Ageing, 2019, 48(1): 16-31.
10. Chen LK, Woo J, Assantachai P, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc, 2020, 21(3): 300-307,e2.
11. Kashani KB, Frazee EN, Kukrálová L, et al. Evaluating muscle mass by using markers of kidney function: development of the sarcopenia index. Crit Care Med, 2017, 45(1): e23-e29.
12. Tan L, Li R, Hu X, et al. Serum creatinine/cystatin C ratio as a case-finding tool for low handgrip strength in Chinese middle-aged and older adults. Sci Rep, 2020, 10(1): 14028.
13. Jenkins AR, Gaynor-Sodeifi K, Lewthwaite H, et al. Efficacy of interventions to alter measures of fat-free mass in people with COPD: a systematic review and meta-analysis. ERJ Open Res, 2023, 9(4): 102-2023.
14. Chai L, Feng W, Zhai C, et al. The association between cystatin C and COPD: a meta-analysis and systematic review. BMC Pulm Med, 2020, 20(1): 182.
15. Jung CY, Joo YS, Kim HW, et al. Creatinine-cystatin C ratio and mortality in patients receiving intensive care and continuous kidney replacement therapy: a retrospective cohort study. Am J Kidney Dis, 2021, 77(4): 509-516.
16. Barreto EF, Poyant JO, Coville HH, et al. Validation of the sarcopenia index to assess muscle mass in the critically ill: a novel application of kidney function markers. Clin Nutr, 2019, 38(3): 1362-1367.
17. Fu X, Tian Z, Wen S, et al. A new index based on serum creatinine and cystatin C is useful for assessing sarcopenia in patients with advanced cancer. Nutrition, 2021, 82: 111032.
18. Osaka T, Hamaguchi M, Hashimoto Y, et al. Decreased the creatinine to cystatin C ratio is a surrogate marker of sarcopenia in patients with type 2 diabetes. Diabetes Res Clin Pract, 2018, 139: 52-58.
19. Tang T, Zhuo Y, Xie L, et al. Sarcopenia index based on serum creatinine and cystatin C is associated with 3-year mortality in hospitalized older patients. Sci Rep, 2020, 10: 1260.
20. Lee HS, Park KW, Kang J, et al. Sarcopenia index as a predictor of clinical outcomes in older patients with coronary artery disease. J Clin Med, 2020, 9(10): 3121.
21. Komorita Y, Iwase M, Fujii H, et al. The serum creatinine to cystatin C ratio predicts bone fracture in patients with type 2 diabetes: The Fukuoka Diabetes Registry. Diabetes Res Clin Pract, 2018, 146: 202-210.
22. Wang K, Jia S, Zhao W, et al. The creatinine-to-cystatin C ratio (a surrogate marker of muscle mass) as a predictor of lung function decline in older adults: A nationwide longitudinal study in China. Respir Med, 2023, 211: 107197.
23. Lin YL, Chang IC, Liou HH, et al. Serum indices based on creatinine and cystatin C predict mortality in patients with nondialysis chronic kidney disease. Sci Rep, 2021, 11(1): 16863.
24. Benz E, Trajanoska K, Lahoeuse L, et al. Sarcopenia in COPD: a systematic review and meta-analysis. Eur Respir Rev, 2019, 28(154): 190049.
25. Huang D, Xie C, Sun C, et al. Serum creatinine to cystatin C ratio is an effective indicator for muscle strength decline in men with acute exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2022, 17: 781-789.
26. Ma K, Huang F, Qiao R, et al. Pathogenesis of sarcopenia in chronic obstructive pulmonary disease. Front Physiol, 2022, 13: 850964.
27. Hirai K, Tanaka A, Homma T, et al. Serum creatinine/cystatin C ratio as a surrogate marker for sarcopenia in patients with chronic obstructive pulmonary disease. Clin Nutr, 2021, 40(3): 1274-1280.
28. Stevens LA, Schmid CH, Greene T, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int, 2009, 75(6): 652-660.
29. Li J, Sun Q, Zhang H, et al. Serum-creatinine-to-cystatin C-to-waist-circumference ratios as an indicator of severe airflow limitation in older adults. J Clin Med, 2023, 12(22): 7116.
30. Zhang M, Li Y, Yang X, et al. Serum cystatin C as an inflammatory marker in exacerbated and convalescent COPD patients. Inflammation, 2016, 39: 625-631.
31. 焦彬, 丁岩冰, 梁兰玉, 等. 血肌酐与胱抑素 C 的比值在溃疡性结肠炎合并骨骼肌质量减少中的意义. 现代消化及介入诊疗, 2022, 27: 1392-1396.
32. Nishiki K, Nojiri M, Kato R, et al. Serum creatinine/cystatin C ratio associated with cross-sectional area of erector spinae muscles and pulmonary function in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2021, 16: 3513-3524.
33. Chen Z, Zha L, Ma X, et al. Serum creatinine/cystatin C ratio as a predictor of in-hospital mortality in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Lung, 2022, 200(5): 609-617.
34. Qiu S, Cai X, Yuan Y, et al. Changes in creatinine-to-cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: the China health and retirement longitudinal study. J Diabetes, 2021, 13(12): 1025-1033.
35. 中国高血压防治指南修订委员会. 中国高血压防治指南 (2024 年修订版). 中华高血压杂志, 2024, 32(7): 603-700.

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