Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug;71(8):1297-1307.
doi: 10.1002/art.40859. Epub 2019 May 29.

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

Alexandra Legge  1 , Susan Kirkland  1 , Kenneth Rockwood  1 , Pantelis Andreou  1 , Sang-Cheol Bae  2 , Caroline Gordon  3 , Juanita Romero-Diaz  4 , Jorge Sanchez-Guerrero  4 , Daniel J Wallace  5 , Sasha Bernatsky  6 , Ann E Clarke  7 , Joan T Merrill  8 , Ellen M Ginzler  9 , Paul Fortin  10 , Dafna D Gladman  11 , Murray B Urowitz  11 , Ian N Bruce  12 , David A Isenberg  13 , Anisur Rahman  13 , Graciela S Alarcón  14 , Michelle Petri  15 , Munther A Khamashta  16 , M A Dooley  17 , Rosalind Ramsey-Goldman  18 , Susan Manzi  19 , Kristjan Steinsson  20 , Asad A Zoma  21 , Cynthia Aranow  22 , Meggan Mackay  22 , Guillermo Ruiz-Irastorza  23 , S Sam Lim  24 , Murat Inanc  25 , Ronald F van Vollenhoven  26 , Andreas Jonsen  27 , Ola Nived  27 , Manuel Ramos-Casals  28 , Diane L Kamen  29 , Kenneth C Kalunian  30 , Soren Jacobsen  31 , Christine A Peschken  32 , Anca Askanase  33 , John G Hanly  34
Affiliations

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

Alexandra Legge et al. Arthritis Rheumatol. 2019 Aug.

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.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Observed distribution of SLICC-FI values at baseline (n=1682) and at last follow-up visit (n=1507) among SLE patients in the SLICC inception cohort.
Figure 2:
Figure 2:
Distribution of the change in SLICC-FI values from the baseline assessment to the last follow-up visit among SLE patients in the SLICC inception cohort (n=1506).
Figure 3:
Figure 3:
Kaplan-Meier survival curves for the risk of mortality during follow-up among SLE patients in the SLICC inception cohort, overall (A) and stratified by baseline frailty status (B).
See this image and copyright information in PMC

References

    1. Strand V, Chu AD. Measuring outcomes in systemic lupus erythematosus clinical trials. Expert Rev Pharmacoecon Outcomes Res 2011;11:455–468. - PubMed
    1. Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum 1996;39:363–369. - PubMed
    1. Bruce IN, O’Keeffe AG, Farewell V, Hanly JG, Manzi S, Su L, et al. Factors associated with damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort. Ann Rheum Dis 2015;74:1706–1713. - PMC - PubMed
    1. Alarcón GS, Roseman JM, McGwin G, Uribe A, Bastian HM, Fessler BJ, et al. Systemic lupus erythematosus in three ethnic groups. XX. Damage as a predictor of further damage. Rheumatology (Oxford) 2004;43:202–205. - PubMed
    1. Cardoso CRL, Signorelli FV, Papi JAS, Salles GF. Initial and accrued damage as predictors of mortality in Brazilian patients with systemic lupus erythematosus: a cohort study. Lupus 2008;17:1042–1048. - PubMed

Publication types