SLICC-Frailty Index is independently associated with impaired physical function, activities of daily living and quality of life measures

Abstract

Objective The Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) was developed to assess health deficits including disease activity, organ damage, comorbidities and functional status. We examined any relationship between SLICC-FI and objective physical function measures, activities of daily living (ADL) performance, and quality of life in Systemic Lupus Erythematosus (SLE). Methods SLICC-FI was estimated using data from patient files and patient-reported questionnaires. Jamar Dynamometer, pinch gauge and Purdue pegboard test measured grip strength, pinch strength and dexterity, respectively. ADL performance was assessed by the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, and Health Assessment Questionnaire (HAQ). Quality of life was evaluated by LupusQol questionnaire. Results This cross-sectional study included 240 SLE patients (90% female, mean (SD) age: 47.63 (13.01), median (IQR) disease duration: 9 (4-16). Mean (SD) SLICC-FI was 0.09 (0.06). Forty-three (17.9%) patients were classified as robust, 105 (43.8%) as relatively less fit, 77 (32.1%) as least fit, and 15 (6.2%) as frail. In univariate analysis, SLICC-FI was significantly associated with DASH and HAQ with an inverse association with grip strength, pinch strength, and all purdue scores (all p < 0.001). A negative correlation was found between SLICC-FI score and all LupusQoL domain scores (all p < 0.001). All associations remained statistically significant in multivariate regression analysis, after adjustment for age, disease duration, SLEDAI-2K, SLICC, immunosuppressives, corticosteroids and Charlson score. Conclusion SLICC-FI is independently associated with poor physical function and ADL performance and impaired quality of life and may help to identify patients in need for additional interventions beyond routine care.

SLICC-Frailty Index and Its Association with Low Bone Mineral Density and Vertebral Fractures in Women with Systemic Lupus Erythematosus

“…There were some interesting differences in the risk factors for fracture between patients regarded as frail and those with less frailty or those who were not frail; the frail group was older, menopausal, had a higher cumulative GCT dose, and a lower BMD. Some of these differences have been previously identified [ 14 ]. Therefore, we consider that measuring frailty in patients with SLE may provide an essential understanding of patient’s global health condition and the risk of deficient health status, such as VF.…”

“…Our results, when incorporated into other studies, emphasize the relevance of frailty when assessing VF in patients with rheumatic diseases, such as rheumatoid arthritis [ 28 , 29 ]. In terms of the frailty tool utilized in our study, this Index (the SLICC-FI) has been well validated and predicts several other outcomes, such as hospitalizations [ 13 ], organ damage [ 12 ], poor HRQL [ 14 ], and mortality [ 23 ].…”

“…In addition, because we assessed bone loss as an outcome, we excluded the item “osteoporosis.” The SLICC-FI score was estimated for each patient as the sum of their individual health deficit scores divided by the total number of deficits. The participants were classified as robust (SLICC-FI ≤ 0.03), relatively less fit (0.03 < SLICC-FI ≤ 0.21), or frail (SLICC-FI > 0.21) [ 14 , 24 ].…”

“…The Systemic Lupus International Collaborating Clinics-Frailty Index (SLICC-FI) consist of disease activity, organ damage, comorbidities, and HRQL assessments and is generated and validated in a large population, including mestizo patients [ 11 ]. In addition, the index predicts hospitalizations, organ damage, and mortality in lupus [ 10 , 12 , 13 ], and more recently, the SLICC-FI was related to impaired physical activity [ 14 ]. In the multicenter LUpus in MInorities, NAture versus nurture (LUMINA) cohort, including Hispanic participants, SLICC-FI was also associated with organ damage [ 15 ].…”