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Lieber SB, Nahid M, Legge A, Rajan M, Lipschultz RA, Lin M, Reid MC, Mandl LA. Comparison of two frailty definitions in women with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:1384-1390. [PMID: 37555816 PMCID: PMC11065438 DOI: 10.1093/rheumatology/kead393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES Frailty is a risk factor for adverse health in SLE. The Fried phenotype (FP) and the SLICC Frailty Index (SLICC-FI) are common frailty metrics reflecting distinct approaches to frailty assessment. We aimed to (1) compare frailty prevalence according to both metrics in women with SLE and describe differences between frail and non-frail participants using each method and (2) evaluate for cross-sectional associations between each metric and self-reported disability. METHODS Women aged 18-70 years with SLE were enrolled. FP and SLICC-FI were measured, and agreement calculated using a kappa statistic. Physician-reported disease activity and damage, Patient Reported Outcome Measurement Information System (PROMIS) computerized adaptive tests, and Valued Life Activities (VLA) self-reported disability were assessed. Differences between frail and non-frail participants were evaluated cross-sectionally, and the association of frailty with disability was determined for both metrics. RESULTS Of 67 participants, 17.9% (FP) and 26.9% (SLICC-FI) were frail according to each metric (kappa = 0.41, P < 0.01). Compared with non-frail women, frail women had greater disease damage, worse PROMIS scores, and greater disability (all P < 0.01 for FP and SLICC-FI). After age adjustment, frailty remained associated with a greater odds of disability [FP: odds ratio (OR) 4.7, 95% CI 1.2, 18.8; SLICC-FI: OR 4.6, 95% CI 1.3, 15.8]. CONCLUSION Frailty is present in 17.9-26.9% of women with SLE. These metrics identified a similar, but non-identical group of women as frail. Further studies are needed to explore which metric is most informative in this population.
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Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Musarrat Nahid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra Legge
- Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Myriam Lin
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - M Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Mendoza-Pinto C, Etchegaray-Morales I, Munguía-Realpozo P, Méndez-Martínez S, Ayón-Aguilar J, Arellano-Avendaño F, Montel-Jarquín ÁJ, García-Carrasco M. SLICC-Frailty Index and Its Association with Low Bone Mineral Density and Vertebral Fractures in Women with Systemic Lupus Erythematosus. Calcif Tissue Int 2023; 113:475-480. [PMID: 37481761 PMCID: PMC10618373 DOI: 10.1007/s00223-023-01117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
The Systemic Lupus International Clinics (SLICC)-Frailty Index (FI) is associated with adverse outcomes in systemic lupus erythematosus (SLE). However, to our knowledge, its association with bone mineral density (BMD) and vertebral fractures (VF), has not been investigated using a standardized methods. Our aim was to evaluate the relationship between frailty assessed by SLICC-FI, and BMD and VF in Mestizo women with SLE. Adult women were included in this cross-sectional study. Information concerning the risk factors for VF and BMD in the lumbar spine and total hip was acquired. SLICC-FI was assessed at baseline. A semi-quantitative method was utilized to evaluate the prevalence of VF on lateral thoracolumbar radiographs. Univariate and multivariate regression analyses were performed adjusting for age, body mass index (BMI), SLE duration, cumulative glucocorticoid dose, bisphosphonate use, and BMD measurements. We included 202 women with SLE (mean age [SD] = 43.3 [13.6] years). The mean (SD) SLICC-FI value was 0.14 (0.09). Eleven (5.4%) patients were categorized as robust, 62 (30.7%) as relatively less fit, 84 (41.6%) as least fit, and 45 (22.3%) as frail. Both univariate and multivariate models showed associations between frailty (defined as SLICC-FI > 0.21) and prevalent VF in the entire population (OR 5.76, 95% CI 2.53-13.12; P < 0.001) and in the premenopausal group (OR 4.29, 95% CI; P = 0.047). We also found an association between the SLICC-FI and low BMD. In conclusion, frailty assessed by SLICC-FI might be associated with VF and low BMD in mestizo females with SLE.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Puebla, Mexico
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Puebla, Mexico.
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | | | - Jorge Ayón-Aguilar
- Health Research Medical Coordinator, Mexican Social Security Institute, Puebla Delegation, Puebla, Mexico
| | | | | | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
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Lieber SB, Nahid M, Navarro-Millán I, Rajan M, Sattui SE, Mandl LA. Frailty and emergency department utilisation in adults with systemic lupus erythematosus ≤65 years of age: an administrative claims data analysis of Medicaid beneficiaries. Lupus Sci Med 2023; 10:e000905. [PMID: 37524516 PMCID: PMC10391790 DOI: 10.1136/lupus-2023-000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Frailty is a risk factor for adverse health in adults with SLE, including those <65 years. Emergency department (ED) utilisation is high in adults with SLE, but to our knowledge, whether frailty is associated with ED use is unknown. In a large administrative claims dataset, we assessed risk of ED utilisation among frail adults with SLE ≤65 years of age relative to non-frail adults ≤65 years of age with SLE. METHODS Using the MarketScan Medicaid subset from 2011 to 2015, we identified beneficiaries 18-65 years with SLE (≥3 SLE International Classification of Diseases, Ninth Revision codes ≥30 days apart). Comparators without a systemic rheumatic disease (SRD) were matched 4:1 on age and gender. Frailty status in 2011 was determined using two claims-based frailty indices (CFIs). We compared risk of recurrent ED utilisation among frail and non-frail beneficiaries with SLE using an extension of the Cox proportional hazard model for recurrent events data. RESULTS Of 2262 beneficiaries with SLE and 9048 non-SRD comparators, 28.8% and 11.6% were frail, respectively, according to both CFIs. Compared with non-frail beneficiaries with SLE, frail beneficiaries with SLE had significantly higher hazard of recurrent ED use (HR 1.75, 95% CI 1.48 to 2.08). CONCLUSION Frailty increased hazard of recurrent ED visits in frail adults ≤65 years of age with SLE relative to comparable non-frail adults with SLE. Frailty is a potential target for efforts to improve quality of care in SLE.
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Affiliation(s)
- Sarah B Lieber
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Musarrat Nahid
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Iris Navarro-Millán
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Mangala Rajan
- Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Sebastian E Sattui
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York City, New York, USA
- Medicine, Weill Cornell Medicine, New York City, New York, USA
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Elera-Fitzcarrald C, Gamboa-Cárdenas RV, Reatégui-Sokolova C, Pimentel-Quiroz V, Rodriguez-Bellido Z, Pastor-Asurza CA, Perich-Campos R, Alarcón GS, Ugarte-Gil MF. The SLICC-FI Predicts Damage Accrual in SLE Patients. Data From the Almenara Lupus Cohort. Lupus 2022; 31:1666-1670. [PMID: 36165429 DOI: 10.1177/09612033221126855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) as a predictor of damage accrual in a primarily Mestizo SLE patient cohort. METHODS Patients from a single-center prevalent cohort were included. Damage accrual was defined as the increase in the SLICC/American College of Rheumatology (ACR) damage index (SDI) scores between the baseline and the last visits. The SLICC-FI was measured at baseline. Univariable and multivariable Cox regression models were performed to determine the association between the baseline SLICC-FI (per 0.05 increase) and the increase in the SDI, adjusted for possible confounders. Alternative analyses using negative binomial regression models including the difference between the last and the first SDI as outcome were performed. RESULTS Of the 265 patients included, 248 (93.6%) were female with mean (SD) age of 35.1 (13.6) years at diagnosis. At baseline, mean (SD) SLE disease duration was 7.3 (6.5) years, SDI was 1.0 (1.2) and the SLICC-FI was 0.22 (0.05). After a mean (SD) of 5.2 (2.2) years of follow-up, the SDI increased in 126 (47.5%) patients, and the final mean (SD) SDI score was 1.7 (1.7). Higher SLICC-FI scores at baseline predicted greater damage accrual in the univariable analysis [Hazard Ratio (HR) =1.38, (CI95% 1.16-1.65); p < 0.001] and in the multivariable model, after adjustment for possible confounders [HR = 1.30 (CI95% 1.02-1.66); p = 0.033]. CONCLUSION SLICC-FI predicts the occurrence of damage accrual in a prevalent SLE Latin-American cohort with short or long disease duration, supporting the relevance of this index in the evaluation of SLE patients.
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Affiliation(s)
- Claudia Elera-Fitzcarrald
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Escuela Profesional de Medicina Humana, 33222Universidad Privada San Juan Bautista, Ica, Perú
| | - Rocío V Gamboa-Cárdenas
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, 9968Universidad Científica del Sur, Lima, Perú
| | - Cristina Reatégui-Sokolova
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Victor Pimentel-Quiroz
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, 9968Universidad Científica del Sur, Lima, Perú
| | - Zoila Rodriguez-Bellido
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - César A Pastor-Asurza
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Risto Perich-Campos
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú; Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Graciela S Alarcón
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Manuel F Ugarte-Gil
- Rheumatology Department, 280155Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, 9968Universidad Científica del Sur, Lima, Perú
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