Journal
ARTHRITIS & RHEUMATOLOGY
Volume 71, Issue 8, Pages 1297-1307Publisher
WILEY
DOI: 10.1002/art.40859
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Funding
- CIHR [MOP-88526] Funding Source: Medline
- NCATS NIH HHS [UL1 TR000150, UL1 TR001422] Funding Source: Medline
- NCRR NIH HHS [UL1 RR025741, M01 RR000046] Funding Source: Medline
- NIAMS NIH HHS [P30 AR072579, P60 AR048098, R01 AR069572, K24 AR002138, R01 AR043727, P60 AR064464] Funding Source: Medline
- Wellcome Trust Funding Source: Medline
- Danish Rheumatism Association [A3865] Funding Source: Medline
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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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