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Arthritis Rheumatol. 2019 Feb 16. doi: 10.1002/art.40859. [Epub ahead of print]

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

Author information

1
Dalhousie University, Halifax, Nova Scotia, Canada.
2
Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea.
3
University of Birmingham, Birmingham, UK.
4
Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
5
Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles.
6
McGill University, Montreal, Quebec, Canada.
7
University of Calgary, Calgary, Alberta, Canada.
8
Oklahoma Medical Research Foundation, Oklahoma City.
9
SUNY Downstate Medical Center, Brooklyn, New York.
10
CHU de Québec et Université Laval, Quebec City, Canada.
11
Toronto Western Hospital and University of Toronto, Ontario, Canada.
12
University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
13
University College London, London, UK.
14
University of Alabama at Birmingham.
15
Johns Hopkins University School of Medicine, Baltimore, Maryland.
16
St Thomas' Hospital, King's College London School of Medicine, London, UK.
17
University of North Carolina, Chapel Hill.
18
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
19
Allegheny Health Network, Pittsburgh, Pennsylvania.
20
Landspitali University Hospital, Reykjavik, Iceland.
21
Hairmyres Hospital, East Kilbride, Scotland, UK.
22
Feinstein Institute for Medical Research, Manhasset, New York.
23
Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
24
Emory University School of Medicine, Atlanta, Georgia.
25
Istanbul University, Istanbul, Turkey.
26
Karolinska Institute, Stockholm, Sweden.
27
Lund University, Lund, Sweden.
28
Hospital Clínic de Barcelona, Barcelona, Spain.
29
Medical University of South Carolina, Charleston.
30
University of California San Diego School of Medicine, La Jolla.
31
Copenhagen University Hospital, Copenhagen, Denmark.
32
University of Manitoba, Winnipeg, Manitoba, Canada.
33
Hospital for Joint Diseases, New York University, New York.
34
Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.

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.

PMID:
30771242
DOI:
10.1002/art.40859

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