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Publication Detail
Evaluating the properties of a frailty index and its association with mortality risk among patients with systemic lupus erythematosus.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Legge A, Kirkland S, Rockwood K, Andreou P, Bae S-C, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin P, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Steinsson K, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG
  • Publication date:
    08/2019
  • Journal:
    Arthritis Rheumatol
  • Status:
    Published online
  • Country:
    United States
  • Language:
    eng
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 SLE. METHODS: For this secondary analysis, the baseline visit was defined as the first study visit at which both organ damage (SLICC/ACR Damage Index [SDI]) and health-related quality of life (Short-Form 36 [SF-36]) 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: The 1683 SLE patients in the baseline dataset were 89% female with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months. At baseline, the mean (SD) SLICC-FI score was 0.17 (0.08) with a range from 0 to 0.51. Baseline SLICC-FI values exhibited the expected measurement properties and were weakly correlated with baseline SDI scores (r=0.262; p<0.0001). Higher baseline SLICC-FI values (per 0.05 increment) were associated with increased mortality risk (Hazard Ratio 1.59; 95%CI 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 predicts future mortality risk. The SLICC-FI is potentially valuable for quantifying vulnerability among patients with SLE, and adds to existing prognostic scores. This article is protected by copyright. All rights reserved.
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