Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus

Alexandra Legge, Susan Kirkland, Kenneth Rockwood, Pantelis Andreou, Sang Cheol Bae, Caroline Gordon, Juanita Romero-Diaz, Jorge Sanchez-Guerrero, Daniel J. Wallace, Sasha Bernatsky, Ann E. Clarke, Joan T Merrill, Ellen M. Ginzler, Paul Fortin, Dafna D. Gladman, Murray B. Urowitz, Ian N. Bruce, David A Isenberg, Anisur Rahman, Graciela S. AlarcónMichelle Petri, Munther A. Khamashta, M. A. Dooley, Rosalind Ramsey-Goldman, Susan Manzi, Kristjan Steinsson, Asad A. Zoma, Cynthia Aranow, Meggan Mackay, Guillermo Ruiz-Irastorza, S. Sam Lim, Murat Inanc, Ronald F. van Vollenhoven, Andreas Jonsen, Ola Nived, Manuel Ramos-Casals, Diane L. Kamen, Kenneth C Kalunian, Soren Jacobsen, Christine A. Peschken, Anca Askanase, John G. Hanly

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). Methods: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. Results: In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0–0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35–1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. Conclusion: The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.

Original languageEnglish (US)
JournalArthritis and Rheumatology
DOIs
StatePublished - Jan 1 2019

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Systemic Lupus Erythematosus
Mortality
Health
Comorbidity
Odds Ratio
Steroids
Quality of Life
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

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Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. / Legge, Alexandra; Kirkland, Susan; Rockwood, Kenneth; Andreou, Pantelis; Bae, Sang Cheol; Gordon, Caroline; Romero-Diaz, Juanita; Sanchez-Guerrero, Jorge; Wallace, Daniel J.; Bernatsky, Sasha; Clarke, Ann E.; Merrill, Joan T; Ginzler, Ellen M.; Fortin, Paul; Gladman, Dafna D.; Urowitz, Murray B.; Bruce, Ian N.; Isenberg, David A; Rahman, Anisur; Alarcón, Graciela S.; Petri, Michelle; Khamashta, Munther A.; Dooley, M. A.; Ramsey-Goldman, Rosalind; Manzi, Susan; Steinsson, Kristjan; Zoma, Asad A.; Aranow, Cynthia; Mackay, Meggan; Ruiz-Irastorza, Guillermo; Lim, S. Sam; Inanc, Murat; van Vollenhoven, Ronald F.; Jonsen, Andreas; Nived, Ola; Ramos-Casals, Manuel; Kamen, Diane L.; Kalunian, Kenneth C; Jacobsen, Soren; Peschken, Christine A.; Askanase, Anca; Hanly, John G.

In: Arthritis and Rheumatology, 01.01.2019.

Research output: Contribution to journalArticle

Legge, A, Kirkland, S, Rockwood, K, Andreou, P, Bae, SC, Gordon, C, Romero-Diaz, J, Sanchez-Guerrero, J, Wallace, DJ, Bernatsky, S, Clarke, AE, Merrill, JT, Ginzler, EM, Fortin, P, Gladman, DD, Urowitz, MB, Bruce, IN, Isenberg, DA, Rahman, A, Alarcón, GS, Petri, M, Khamashta, MA, Dooley, MA, Ramsey-Goldman, R, Manzi, S, Steinsson, K, Zoma, AA, Aranow, C, Mackay, M, Ruiz-Irastorza, G, Lim, SS, Inanc, M, van Vollenhoven, RF, Jonsen, A, Nived, O, Ramos-Casals, M, Kamen, DL, Kalunian, KC, Jacobsen, S, Peschken, CA, Askanase, A & Hanly, JG 2019, 'Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus', Arthritis and Rheumatology. https://doi.org/10.1002/art.40859
Legge, Alexandra ; Kirkland, Susan ; Rockwood, Kenneth ; Andreou, Pantelis ; Bae, Sang Cheol ; Gordon, Caroline ; Romero-Diaz, Juanita ; Sanchez-Guerrero, Jorge ; Wallace, Daniel J. ; Bernatsky, Sasha ; Clarke, Ann E. ; Merrill, Joan T ; Ginzler, Ellen M. ; Fortin, Paul ; Gladman, Dafna D. ; Urowitz, Murray B. ; Bruce, Ian N. ; Isenberg, David A ; Rahman, Anisur ; Alarcón, Graciela S. ; Petri, Michelle ; Khamashta, Munther A. ; Dooley, M. A. ; Ramsey-Goldman, Rosalind ; Manzi, Susan ; Steinsson, Kristjan ; Zoma, Asad A. ; Aranow, Cynthia ; Mackay, Meggan ; Ruiz-Irastorza, Guillermo ; Lim, S. Sam ; Inanc, Murat ; van Vollenhoven, Ronald F. ; Jonsen, Andreas ; Nived, Ola ; Ramos-Casals, Manuel ; Kamen, Diane L. ; Kalunian, Kenneth C ; Jacobsen, Soren ; Peschken, Christine A. ; Askanase, Anca ; Hanly, John G. / Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. In: Arthritis and Rheumatology. 2019.
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title = "Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus",
abstract = "Objective: To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). Methods: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. Results: In the baseline data set of 1,683 patients with SLE, 89{\%} were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0–0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95{\%} confidence interval 1.35–1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. Conclusion: The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.",
author = "Alexandra Legge and Susan Kirkland and Kenneth Rockwood and Pantelis Andreou and Bae, {Sang Cheol} and Caroline Gordon and Juanita Romero-Diaz and Jorge Sanchez-Guerrero and Wallace, {Daniel J.} and Sasha Bernatsky and Clarke, {Ann E.} and Joan T Merrill and Ginzler, {Ellen M.} and Paul Fortin and Gladman, {Dafna D.} and Urowitz, {Murray B.} and Bruce, {Ian N.} and David A Isenberg and Anisur Rahman and Alarc{\'o}n, {Graciela S.} and Michelle Petri and Khamashta, {Munther A.} and Dooley, {M. A.} and Rosalind Ramsey-Goldman and Susan Manzi and Kristjan Steinsson and Zoma, {Asad A.} and Cynthia Aranow and Meggan Mackay and Guillermo Ruiz-Irastorza and Lim, {S. Sam} and Murat Inanc and {van Vollenhoven}, {Ronald F.} and Andreas Jonsen and Ola Nived and Manuel Ramos-Casals and Kamen, {Diane L.} and Kenneth C Kalunian and Soren Jacobsen and Peschken, {Christine A.} and Anca Askanase and Hanly, {John G.}",
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month = "1",
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TY - JOUR

T1 - Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus

AU - Legge, Alexandra

AU - Kirkland, Susan

AU - Rockwood, Kenneth

AU - Andreou, Pantelis

AU - Bae, Sang Cheol

AU - Gordon, Caroline

AU - Romero-Diaz, Juanita

AU - Sanchez-Guerrero, Jorge

AU - Wallace, Daniel J.

AU - Bernatsky, Sasha

AU - Clarke, Ann E.

AU - Merrill, Joan T

AU - Ginzler, Ellen M.

AU - Fortin, Paul

AU - Gladman, Dafna D.

AU - Urowitz, Murray B.

AU - Bruce, Ian N.

AU - Isenberg, David A

AU - Rahman, Anisur

AU - Alarcón, Graciela S.

AU - Petri, Michelle

AU - Khamashta, Munther A.

AU - Dooley, M. A.

AU - Ramsey-Goldman, Rosalind

AU - Manzi, Susan

AU - Steinsson, Kristjan

AU - Zoma, Asad A.

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Inanc, Murat

AU - van Vollenhoven, Ronald F.

AU - Jonsen, Andreas

AU - Nived, Ola

AU - Ramos-Casals, Manuel

AU - Kamen, Diane L.

AU - Kalunian, Kenneth C

AU - Jacobsen, Soren

AU - Peschken, Christine A.

AU - Askanase, Anca

AU - Hanly, John G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). Methods: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. Results: In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0–0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35–1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. Conclusion: The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.

AB - Objective: To evaluate the properties of a frailty index (FI), constructed using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort, as a novel health measure in systemic lupus erythematosus (SLE). Methods: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36] scores) were assessed. The SLICC-FI was constructed using baseline data. The SLICC-FI comprises 48 health deficits, including items related to organ damage, disease activity, comorbidities, and functional status. Content, construct, and criterion validity of the SLICC-FI were assessed. Multivariable Cox regression was used to estimate the association between baseline SLICC-FI values and mortality risk, adjusting for demographic and clinical factors. Results: In the baseline data set of 1,683 patients with SLE, 89% were female, the mean ± SD age was 35.7 ± 13.4 years, and the mean ± SD disease duration was 18.8 ± 15.7 months. At baseline, the mean ± SD SLICC-FI score was 0.17 ± 0.08 (range 0–0.51). Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r = 0.26, P < 0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (hazard ratio 1.59, 95% confidence interval 1.35–1.87), after adjusting for age, sex, steroid use, ethnicity/region, and baseline SDI scores. Conclusion: The SLICC-FI demonstrates internal validity as a health measure in SLE and might be used to predict future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores.

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