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)
Pages (from-to)1297-1307
Number of pages11
JournalArthritis and Rheumatology
Volume71
Issue number8
DOIs
StatePublished - Aug 2019

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

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    Legge, A., Kirkland, S., Rockwood, K., Andreou, P., Bae, S. C., Gordon, C., Romero-Diaz, J., Sanchez-Guerrero, J., Wallace, D. J., Bernatsky, S., Clarke, A. E., Merrill, JT., Ginzler, E. M., Fortin, P., Gladman, D. D., Urowitz, M. B., Bruce, I. N., Isenberg, DA., Rahman, A., ... Hanly, J. G. (2019). Evaluating the Properties of a Frailty Index and Its Association With Mortality Risk Among Patients With Systemic Lupus Erythematosus. Arthritis and Rheumatology, 71(8), 1297-1307. https://doi.org/10.1002/art.40859