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Construction of a Frailty Index as a Novel Health Measure in Systemic Lupus Erythematosus
Alexandra Legge1,2, Susan Kirkland1,2, Kenneth Rockwood1,2
1From the Divisions of Rheumatology and Geriatric Medicine, Department of Medicine, Dalhousie University; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal; Division of Rheumatology, Centre Hospitalier Universitaire (CHU) de Québec et Université Laval, Quebec City, Quebec; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea; Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Objective:
To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort.
Methods:
The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values.
Results:
The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21.
Conclusion:
The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.
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