Association of the Systemic Lupus International Collaborating Clinics Frailty Index and Damage Accrual in Longstanding Systemic Lupus Erythematosus

Abstract

Objective. To externally validate the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) in a prevalent systemic lupus erythematosus (SLE) cohort and to assess the ability of the SLICC-FI to predict organ damage accrual among individuals with longstanding SLE.Methods. This was a secondary analysis of data from the Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE) cohort, which consists of adult women from the Chicago Lupus Database who met the 1997 revised American College of Rheumatology (ACR) classification criteria for SLE. There were 185 patients with SLE enrolled, of whom 149 patients were included in a 5-year follow-up analysis. The SLICC-FI and SLICC/ACR Damage Index (SDI) scores were calculated at baseline and 5-year follow-up. Unadjusted and adjusted logistic regression models estimated the association of baseline SLICC-FI scores (per 0.05 increase) with damage accrual at 5-year follow-up.Results. At enrollment the mean ± SD age of the 149 patients was 43.30 ± 10.15 years, the mean ± SD disease duration was 11.93 ± 8.46 years, and the mean ± SD SDI score was 1.64 ± 1.83. At baseline, the mean ± SD SLICC-FI score was 0.18 ± 0.08, and 36% of participants were categorized as frail (SLICC-FI score >0.21). In a model adjusted for age, race, and disease duration, each 0.05-unit increase in the baseline SLICC-FI score was associated with 28% higher odds of subsequent damage accrual (odds ratio 1.28, 95% confidence interval 1.01-1.63).Conclusion. In a prevalent cohort of women with established SLE, higher baseline SLICC-FI scores were associated with a higher risk of subsequent damage accrual at 5-year follow-up.

Association of Systemic Lupus International Collaborating Clinics Frailty Index With Damage in Systemic Lupus Erythematosus Patients: Results From a Multiethnic, Multicenter US Cohort of Patients With Lupus

“…The SLICC‐FI score was slightly higher in this cohort (0.26) than in other cohorts, including the SLICC (0.17) (5), the SOLVABLE (0.18) (8), and the Almenara Lupus Cohorts (Peru), with a mean SLICC‐FI score of 0.17 (9); additionally, it is important to point out that the threshold to consider someone as being frail is an SLICC‐FI score of >0.21 (5). The proportion of patients classified as being frail was higher (80.9%) in our cohort than the proportions reported by others (27.5–36.0%) (5,8,16); it is possible that this high rate is explained by the relative poor HRQoL of the patients in the LUMINA cohort (11) or a higher level of disease activity (mild to moderate in the other cohorts, in accordance with the Systemic Lupus Erythematosus Disease Activity Index [5,8,16], and moderate to high in ours, in accordance with the Systemic Lupus Activity Measure); however, other unmeasured factors may explain this high value. Of importance, as frailty is a modifiable state, more studies are needed to evaluate the impact of the variation of the SLICC‐FI in this and other outcome measures.…”

“…The SLICC-FI score was calculated as the sum of all the deficits and divided by the total number of deficits to obtain a proportion between 0 and 1. Previous reports support the predictability of the frailty indices even when some items are excluded, as long as a significant number of deficits are included (usually >30) (6,8,14). Damage accrual was defined using the SLICC/ACR Damage Index (SDI) (15).…”

“…The SLICC-FI includes 48 health deficits related to disease activity, damage, comorbidities as well as health-related quality of life (HRQoL). This index has been validated in the SLICC and the Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE) cohorts (Chicago), being predictive of mortality (6), damage (7)(8)(9), and hospitalizations (10).…”

The SLICC-FI Predicts Damage Accrual in SLE Patients. Data From the Almenara Lupus Cohort

“…The SLICC-FI is an important tool in the evaluation of SLE patients since it predicts damage accrual and assess frailty through deficit accumulation that provides a novel approach to the quantification of vulnerability among SLE patients. 8 In addition, the association between SLICC-FI and damage accrual has been corroborated in the Chicago Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE) 13 study and in the LUMINA cohort, a multi-ethnic, multi-center US cohort. 14…”

“…The SLICC-FI is an important tool in the evaluation of SLE patients since it predicts damage accrual and assess frailty through deficit accumulation that provides a novel approach to the quantification of vulnerability among SLE patients. 8 In addition, the association between SLICC-FI and damage accrual has been corroborated in the Chicago Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE) 13 study and in the LUMINA cohort, a multiethnic, multi-center US cohort. 14 Components of social vulnerability, such as low socioeconomic status, housing instability, and social isolation, behave similarly to health deficits by accumulating slowly over time and having a strong association with adverse health outcomes, so could be successfully included as health deficits in an FI.…”