Can Novel Inflammatory Parameters (UHR, MHR, THR, CAR, CHR, SII) Predict Sarcopenia In Older Adults With Weight Loss?

Abstract Background: Sarcopenia is characterized by age-related loss of muscle mass and function and is associated with chronic low-grade inflammation (inflammaging). Novel inflammation- based indices – including the Uric acid to HDL-cholesterol ratio (UHR), Monocyte to HDL ratio (MHR), Triglyceride to HDL ratio (THR), C-reactive protein (CRP) to albumin ratio (CAR), CRP to HDL ratio (CHR), and Systemic immune-inflammation index (SII) – have emerged as markers of inflammaging. This study investigated the relationship between these inflammatory parameters and probable sarcopenia (PS) in older adults. Methods: 490 patients aged 65 years and older who applied to the geriatric medicine outpatient clinic of a university hospital with complaints of weight loss were evaluated retrospectively cross-sectionally (2022-2023). PS was assessed by SARC-F questionnaire, handgrip strength test (HGST), and the 5 times-sit-to-stand-test (STST), and patients were grouped into probable sarcopenia (PS, n=259) or non-sarcopenia (NS, n=231) based on these criteria. UHR, MHR, THR, CAR, CHR, and SII were calculated from laboratory values. Group differences in demographics, comorbidities, geriatric assessment scores, and these inflammatory markers were analyzed. The correlations between new inflammatory markers and standard inflammatory indicators (CRP, neutrophil) were evaluated. Receiver operating characteristic (ROC) analysis determined the ability of each parameter to discriminate PS. Results: The PS group was older than NS (median 76 vs 71 years, p<0.001) and had higher prevalence of atrial fibrillation (p=0.002) and dementia (p<0.001), while other comorbidities were similar between groups. All inflammatory indices were elevated in the PS group: median UHR 0.11 vs 0.09, MHR (higher in PS), CAR 1.37 vs 1.02, CHR 0.13 vs 0.07 and SII 623.5 vs 479.5 (all p<0.001), and THR higher (2.19 vs 2.15, p=0.012). Serum uric acid, monocyte count and CRP levels were higher in PS than in NS, while albumin and HDL levels were lower (all p<0.01). UHR, CAR, MHR and SII correlated with one another and with CRP and neutrophils (p<0.001 for all). In ROC analysis, UHR showed the area under the curve (AUC 0.638, 95%CI 0.586–0.690) and a cutoff of 0.1204 (sensitivity 44%, specificity 83%) for identifying PS. CAR and SII showed predictive value (AUC 0.602 and 0.626, respectively), while THR had weaker association (AUC 0.566). UHR performed best with 83% specificity, while CAR and SII performed best with 71% sensitivity. Conclusion: Older adults with PS show higher UHR, MHR, THR, CAR, CHR, and SII, reflecting increased inflammatory status. Among them, UHR, CAR and SII have demonstrated the ability to distinguish PS; UHR has high specificity, while CAR and SII have high sensitivity. These available, cost-effective inflammatory markers are associated with sarcopenia-related pathophysiology and established inflammatory markers (CRP, neutrophil). Our findings suggest that inflammatory parameters, especially UHR, CAR and SII may serve as biomarkers to identify older patients at risk for sarcopenia. Future prospective studies are needed to validate their predictive values and to determine whether interventions targeting modifiable components [such as serum uric acid, HDL levels, CRP, albumin, CBC(complete blood count)] affect sarcopenia outcomes.