Background/Purpose: Malnutrition and severe gastrointestinal (GI) dysfunction are the cause of mortality in 4-15% of systemic sclerosis (SSc) patients whereas overall GI involvement is observed in 75-90% of cases. Tools, reliable in other metabolic diseases, such as the Malnutrition Universal Screening Tool (MUST), or adiponectin to leptin ratio (A/L), have not yet been explored for the prediction of severe malnutrition in SSc. Our aim was to explore the performance of MUST and A/L to identify a combined index for stratification of risk of weight loss at 12 months in patients with SSc.

Methods: 180 consecutive SSc patients were enrolled in this multicentre longitudinal study (University of Leeds n=70, University of Messina n=60, University of Padova n=50). Serum levels of adiponectin and leptin were measured and their ratio calculated (A/L). Malnutrition risk was evaluated through MUST, which includes BMI and weight loss reported by the patient in the last 3-6 months, and the score corresponds to the malnutrition risk (0=no, 1=mild, ≥2=moderate/severe). Weight loss ≥10% of baseline weight after 12 months was also calculated.

Results: No statistical differences were observed at baseline among the single centres cohorts. Overall, we observed a BMI decrease over time (24.1 vs 23.1, p<0.0001). 40/180 (22%) SSc patients had a weight loss ≥10% after 12 months. These patients were older (median 63 vs 55, p=0.02), more frequently with the diffuse form (48% vs 31%, p=0.05), Scl70 positive (32% vs 17%, p=0.04), had higher modified Rodnan skin scores (median 10 vs 6, p=0.01), and HRCT evidence of pulmonary fibrosis (55% vs 30%, p=0.003), with concordant lower TLC (mean: 76.7 vs 93.7, p<0.001), and lower FVC (mean: 74.6 vs 83.5, p=0.04). No differences were observed in CK serum levels. In the group of patients with ≥10% weight loss baseline A/L was 2.34 (vs 0.37, p<0.0001), baseline MUST was 1.54 (vs 0.57, p<0.0001), while baseline BMI was 21.4 (vs 24.9, p<0.0001). Using ≥10% weight loss at 12 months as gold standard, we built receiver operating characteristic (ROC) curves for BMI, MUST, A/L and combined indexes. BMI and A/L had a better AUC (0.84; 95% CI: 0.77-0.84) vs MUST (0.77; 95% CI: 0.69/0.77). By combining BMI and A/L in logistic regression, we defined the predictor of malnutrition in systemic sclerosis (PREMASS) with the formula: 3.33 – (0.25 * baseline BMI) + (1.71 * baseline A/L). A PREMASS score >0.21 showed an AUC of 0.80 (95% CI: 0.80 Ð 0.87), 85% sensitivity (95% CI: 74-96) and 83% specificity (95% CI: 77-89) for ≥10% weight loss with an overall 59% positive predictive value (95% CI: 46-71) and 95% negative predictive value (95% CI: 91-99) and a relative risk of 11.9 (95% CI: 5.3-26.8).

Conclusion: Here we propose a novel combined index, PREMASS, for stratification for risk of severe weight loss in the following 12 months in SSc. Further validation in independent cohorts will confirm the clinical value of PREMASS index for the clinical management and risk stratification for weight loss in SSc patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictive-value-of-a-combined-index-for-weight-loss-in-systemic-sclerosis/