Construction of a frailty index as a novel health measure in systemic lupus erythematosus

Alexandra Legge; Susan Kirkland; Kenneth Rockwood; Pantelis Andreou; Sang Cheol Bae; Caroline Gordon; Juanita Romero-Diaz; Jorge Sanchez-Guerrero; Daniel J. Wallace; Sasha Bernatsky; Ann E. Clarke; Joan T. Merrill; Ellen M. Ginzler; Paul Fortin; Dafna D. Gladman; Murray B. Urowitz; Ian N. Bruce; David A. Isenberg; Anisur Rahman; Graciela S. Alarcon; Michelle Petri; Munther A. Khamashta; M. A. Dooley; Rosalind Ramsey-Goldman; Susan Manzi; Asad A. Zoma; Cynthia Aranow; Meggan MacKay; Guillermo Ruiz-Irastorza; S. Sam Lim; Murat Inanc; Ronald F. Van Vollenhoven; Andreas Jonsen; Ola Nived; Manuel Ramos-Casals; Diane L. Kamen; Kenneth C. Kalunian; Soren Jacobsen; Christine A. Peschken; Anca Askanase; John G. Hanly

doi:10.3899/jrheum.181338

Construction of a frailty index as a novel health measure in systemic lupus erythematosus

Alexandra Legge, Susan Kirkland, Kenneth Rockwood, Pantelis Andreou, Sang Cheol Bae, Caroline Gordon, Juanita Romero-Diaz, Jorge Sanchez-Guerrero, Daniel J. Wallace, Sasha Bernatsky, Ann E. Clarke, Joan T. Merrill, Ellen M. Ginzler, Paul Fortin, Dafna D. Gladman, Murray B. Urowitz, Ian N. Bruce, David A. Isenberg, Anisur Rahman, Graciela S. AlarconMichelle Petri, Munther A. Khamashta, M. A. Dooley, Rosalind Ramsey-Goldman, Susan Manzi, Asad A. Zoma, Cynthia Aranow, Meggan MacKay, Guillermo Ruiz-Irastorza, S. Sam Lim, Murat Inanc, Ronald F. Van Vollenhoven, Andreas Jonsen, Ola Nived, Manuel Ramos-Casals, Diane L. Kamen, Kenneth C. Kalunian, Soren Jacobsen, Christine A. Peschken, Anca Askanase, John G. Hanly

Research output: Contribution to journal › Article › peer-review

43 Citations (Scopus)

Abstract

Objective. To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Methods. The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. Results. The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. Conclusion. The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.

Original language	English
Pages (from-to)	72-81
Number of pages	10
Journal	Journal of Rheumatology
Volume	47
Issue number	1
DOIs	https://doi.org/10.3899/jrheum.181338
Publication status	Published - 2020

Bibliographical note

Funding Information:
Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Funding for this work was provided by the Nova Scotia Health Authority Research Fund. Dr. Bae’s work was supported in part by NRF-2017M3A9B4050335, Republic of Korea. Dr. Gordon’s work was supported by Lupus UK and the NIHR/Wellcome Trust Clinical Research Facility. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin presently holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval, and part of this work was done while he was still a Distinguished Senior Investigator of The Arthritis Society. Dr. Bruce is an NIHR Senior Investigator and is supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre, and the NIHR/Wellcome Trust Manchester Clinical Research Facility. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Dr. Isenberg and Dr. Rahman are supported by the NIHR University College London Hospitals Biomedical Research Center. The Hopkins Lupus Cohort is supported by the US National Institutes of Health (NIH; grant AR43727 and 69572). Dr. Dooley’s work was supported by the NIH (grant RR00046). Dr. Ramsey-Goldman’s work was supported by the NIH (grants 5UL1TR001422-02, formerly 8UL1TR000150 and UL-1RR-025741, K24-AR-02318, and P60AR064464 formerly P60-AR-48098). Dr. Ruiz-Irastorza is supported by the Department of Education, Universities and Research of the Basque Government. Dr. Jacobsen is supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). Dr. Hanly is supported by the Canadian Institutes of Health Research (grant MOP-88526). A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University. Address correspondence to Dr. J.G. Hanly, Division of Rheumatology, Nova Scotia Rehabilitation Centre (2nd Floor), 1341 Summer St., Halifax, Nova Scotia B3H 4K4, Canada. E-mail: john.hanly@nshealth.ca Accepted for publication March 27, 2019.

Publisher Copyright:
© 2019. All rights reserved.

ASJC Scopus Subject Areas

Immunology and Allergy
Rheumatology
Immunology

Access to Document

10.3899/jrheum.181338

Cite this

Legge, A., Kirkland, S., Rockwood, K., Andreou, P., Bae, S. C., Gordon, C., Romero-Diaz, J., Sanchez-Guerrero, J., Wallace, D. J., Bernatsky, S., Clarke, A. E., Merrill, J. T., Ginzler, E. M., Fortin, P., Gladman, D. D., Urowitz, M. B., Bruce, I. N., Isenberg, D. A., Rahman, A., ... Hanly, J. G. (2020). Construction of a frailty index as a novel health measure in systemic lupus erythematosus. Journal of Rheumatology, 47(1), 72-81. https://doi.org/10.3899/jrheum.181338

Legge, A, Kirkland, S , Rockwood, K , Andreou, P, Bae, SC, 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, Alarcon, GS, Petri, M, Khamashta, MA, Dooley, MA, Ramsey-Goldman, R, Manzi, S, 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 2020, 'Construction of a frailty index as a novel health measure in systemic lupus erythematosus', Journal of Rheumatology, vol. 47, no. 1, pp. 72-81. https://doi.org/10.3899/jrheum.181338

@article{24963720e7ef45b8a3569cfd35dd4705,

title = "Construction of a frailty index as a novel health measure in systemic lupus erythematosus",

abstract = "Objective. To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Methods. The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. Results. The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. Conclusion. The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.",

author = "Alexandra Legge and Susan Kirkland and Kenneth Rockwood and Pantelis Andreou and Bae, {Sang Cheol} and Caroline Gordon and Juanita Romero-Diaz and Jorge Sanchez-Guerrero and Wallace, {Daniel J.} and Sasha Bernatsky and Clarke, {Ann E.} and Merrill, {Joan T.} and Ginzler, {Ellen M.} and Paul Fortin and Gladman, {Dafna D.} and Urowitz, {Murray B.} and Bruce, {Ian N.} and Isenberg, {David A.} and Anisur Rahman and Alarcon, {Graciela S.} and Michelle Petri and Khamashta, {Munther A.} and Dooley, {M. A.} and Rosalind Ramsey-Goldman and Susan Manzi and Zoma, {Asad A.} and Cynthia Aranow and Meggan MacKay and Guillermo Ruiz-Irastorza and Lim, {S. Sam} and Murat Inanc and {Van Vollenhoven}, {Ronald F.} and Andreas Jonsen and Ola Nived and Manuel Ramos-Casals and Kamen, {Diane L.} and Kalunian, {Kenneth C.} and Soren Jacobsen and Peschken, {Christine A.} and Anca Askanase and Hanly, {John G.}",

note = "Funding Information: Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas{\textquoteright} Hospital, King{\textquoteright}s College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrici{\'o}n, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Cl{\'i}nic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Funding for this work was provided by the Nova Scotia Health Authority Research Fund. Dr. Bae{\textquoteright}s work was supported in part by NRF-2017M3A9B4050335, Republic of Korea. Dr. Gordon{\textquoteright}s work was supported by Lupus UK and the NIHR/Wellcome Trust Clinical Research Facility. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin presently holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Universit{\'e} Laval, and part of this work was done while he was still a Distinguished Senior Investigator of The Arthritis Society. Dr. Bruce is an NIHR Senior Investigator and is supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre, and the NIHR/Wellcome Trust Manchester Clinical Research Facility. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Dr. Isenberg and Dr. Rahman are supported by the NIHR University College London Hospitals Biomedical Research Center. The Hopkins Lupus Cohort is supported by the US National Institutes of Health (NIH; grant AR43727 and 69572). Dr. Dooley{\textquoteright}s work was supported by the NIH (grant RR00046). Dr. Ramsey-Goldman{\textquoteright}s work was supported by the NIH (grants 5UL1TR001422-02, formerly 8UL1TR000150 and UL-1RR-025741, K24-AR-02318, and P60AR064464 formerly P60-AR-48098). Dr. Ruiz-Irastorza is supported by the Department of Education, Universities and Research of the Basque Government. Dr. Jacobsen is supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). Dr. Hanly is supported by the Canadian Institutes of Health Research (grant MOP-88526). A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrici{\'o}n; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrici{\'o}n; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Qu{\'e}bec et Universit{\'e} Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarc{\'o}n, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas{\textquoteright} Hospital, King{\textquoteright}s College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Cl{\'i}nic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University. Address correspondence to Dr. J.G. Hanly, Division of Rheumatology, Nova Scotia Rehabilitation Centre (2nd Floor), 1341 Summer St., Halifax, Nova Scotia B3H 4K4, Canada. E-mail: john.hanly@nshealth.ca Accepted for publication March 27, 2019. Publisher Copyright: {\textcopyright} 2019. All rights reserved.",

year = "2020",

doi = "10.3899/jrheum.181338",

language = "English",

volume = "47",

pages = "72--81",

journal = "Journal of Rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology",

number = "1",

}

TY - JOUR

T1 - Construction of a frailty index as a novel health measure in systemic lupus erythematosus

AU - Legge, Alexandra

AU - Kirkland, Susan

AU - Rockwood, Kenneth

AU - Andreou, Pantelis

AU - Bae, Sang Cheol

AU - Gordon, Caroline

AU - Romero-Diaz, Juanita

AU - Sanchez-Guerrero, Jorge

AU - Wallace, Daniel J.

AU - Bernatsky, Sasha

AU - Clarke, Ann E.

AU - Merrill, Joan T.

AU - Ginzler, Ellen M.

AU - Fortin, Paul

AU - Gladman, Dafna D.

AU - Urowitz, Murray B.

AU - Bruce, Ian N.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Alarcon, Graciela S.

AU - Petri, Michelle

AU - Khamashta, Munther A.

AU - Dooley, M. A.

AU - Ramsey-Goldman, Rosalind

AU - Manzi, Susan

AU - Zoma, Asad A.

AU - Aranow, Cynthia

AU - MacKay, Meggan

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Inanc, Murat

AU - Van Vollenhoven, Ronald F.

AU - Jonsen, Andreas

AU - Nived, Ola

AU - Ramos-Casals, Manuel

AU - Kamen, Diane L.

AU - Kalunian, Kenneth C.

AU - Jacobsen, Soren

AU - Peschken, Christine A.

AU - Askanase, Anca

AU - Hanly, John G.

N1 - Funding Information: Academic Health Science Center, Manchester; Center for Rheumatology, Department of Medicine, University College London, London; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland; Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine, London, UK; Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico; Cedars-Sinai/David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; Northwestern University and Feinberg School of Medicine, Chicago, Illinois; Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania; Feinstein Institute for Medical Research, Manhasset, New York; Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia; Medical University of South Carolina, Charleston, South Carolina; University of California San Diego School of Medicine (UCSD), La Jolla, California; Hospital for Joint Diseases, New York University (NYU), Seligman Center for Advanced Therapeutics, New York, New York, USA; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey; Unit for Clinical Therapy Research (ClinTRID), Karolinska Institute, Stockholm; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden; Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Funding for this work was provided by the Nova Scotia Health Authority Research Fund. Dr. Bae’s work was supported in part by NRF-2017M3A9B4050335, Republic of Korea. Dr. Gordon’s work was supported by Lupus UK and the NIHR/Wellcome Trust Clinical Research Facility. The Montreal General Hospital Lupus Clinic is partially supported by the Singer Family Fund for Lupus Research. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin presently holds a tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval, and part of this work was done while he was still a Distinguished Senior Investigator of The Arthritis Society. Dr. Bruce is an NIHR Senior Investigator and is supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre, and the NIHR/Wellcome Trust Manchester Clinical Research Facility. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. Dr. Isenberg and Dr. Rahman are supported by the NIHR University College London Hospitals Biomedical Research Center. The Hopkins Lupus Cohort is supported by the US National Institutes of Health (NIH; grant AR43727 and 69572). Dr. Dooley’s work was supported by the NIH (grant RR00046). Dr. Ramsey-Goldman’s work was supported by the NIH (grants 5UL1TR001422-02, formerly 8UL1TR000150 and UL-1RR-025741, K24-AR-02318, and P60AR064464 formerly P60-AR-48098). Dr. Ruiz-Irastorza is supported by the Department of Education, Universities and Research of the Basque Government. Dr. Jacobsen is supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). Dr. Hanly is supported by the Canadian Institutes of Health Research (grant MOP-88526). A. Legge, MD, Department of Medicine, Division of Rheumatology, Dalhousie University; S. Kirkland, PhD, Department of Community Health and Epidemiology, Dalhousie University; K. Rockwood, MD, Division of Geriatric Medicine, Department of Medicine, Dalhousie University; P. Andreou, PhD, Department of Community Health and Epidemiology, Dalhousie University; S.C. Bae, MD, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases; C. Gordon, MD, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham; J. Romero-Diaz, MD, Instituto Nacional de Ciencias Medicas y Nutrición; J. Sanchez-Guerrero, MD, Instituto Nacional de Ciencias Medicas y Nutrición; D.J. Wallace, MD, Cedars-Sinai/David Geffen School of Medicine at UCLA; S. Bernatsky, MD, Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University; A.E. Clarke, MD, Division of Rheumatology, Cumming School of Medicine, University of Calgary; J.T. Merrill, MD, Department of Clinical Pharmacology, Oklahoma Medical Research Foundation; E.M. Ginzler, MD, Department of Medicine, SUNY Downstate Medical Center; P. Fortin, MD, Division of Rheumatology, CHU de Québec et Université Laval, D.D. Gladman, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; M.B. Urowitz, MD, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto; I.N. Bruce, MD, Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center; D.A. Isenberg, MD, Center for Rheumatology, Department of Medicine, University College London; A. Rahman, MD, Center for Rheumatology, Department of Medicine, University College London; G.S. Alarcón, MD, Department of Medicine, University of Alabama at Birmingham; M. Petri, MD, Division of Rheumatology, Johns Hopkins University School of Medicine; M.A. Khamashta, MD, Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine; M.A. Dooley, MD, Thurston Arthritis Research Center, University of North Carolina; R. Ramsey-Goldman, MD, Northwestern University and Feinberg School of Medicine; S. Manzi, MD, Lupus Center of Excellence, Allegheny Health Network; A.A. Zoma, MD, Lanarkshire Center for Rheumatology, Hairmyres Hospital; C. Aranow, MD, Feinstein Institute for Medical Research; M. Mackay, MD, Feinstein Institute for Medical Research; G. Ruiz-Irastorza, MD, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country; S.S. Lim, MD, Emory University School of Medicine, Division of Rheumatology; M. Inanc, MD, Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University; R.F. van Vollenhoven, MD, ClinTRID, Karolinska Institute; A. Jonsen, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; O. Nived, MD, Department of Clinical Sciences Lund, Rheumatology, Lund University; M. Ramos-Casals, MD, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic; D.L. Kamen, MD, Medical University of South Carolina; K.C. Kalunian, MD, UCSD School of Medicine; S. Jacobsen, MD, Copenhagen Lupus and Vasculitis Clinic, Section 4242, Rigshospitalet, Copenhagen University Hospital; C.A. Peschken, MD, University of Maniptoba; A. Askanase, MD, Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics; J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University. Address correspondence to Dr. J.G. Hanly, Division of Rheumatology, Nova Scotia Rehabilitation Centre (2nd Floor), 1341 Summer St., Halifax, Nova Scotia B3H 4K4, Canada. E-mail: john.hanly@nshealth.ca Accepted for publication March 27, 2019. Publisher Copyright: © 2019. All rights reserved.

PY - 2020

Y1 - 2020

N2 - Objective. To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Methods. The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. Results. The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. Conclusion. The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.

AB - Objective. To construct a Frailty Index (FI) as a measure of vulnerability to adverse outcomes among patients with systemic lupus erythematosus (SLE), using data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Methods. The SLICC inception cohort consists of recently diagnosed patients with SLE followed annually with clinical and laboratory assessments. For this analysis, the baseline visit was defined as the first study visit at which sufficient information was available for construction of an FI. Following a standard procedure, variables from the SLICC database were evaluated as potential health deficits. Selected health deficits were then used to generate a SLICC-FI. The prevalence of frailty in the baseline dataset was evaluated using established cutpoints for FI values. Results. The 1683 patients with SLE (92.1% of the overall cohort) eligible for inclusion in the baseline dataset were mostly female (89%) with mean (SD) age 35.7 (13.4) years and mean (SD) disease duration 18.8 (15.7) months at baseline. Of 222 variables, 48 met criteria for inclusion in the SLICC-FI. Mean (SD) SLICC-FI was 0.17 (0.08) with a range from 0 to 0.51. At baseline, 27.1% (95% CI 25.0-29.2) of patients were classified as frail, based on SLICC-FI values > 0.21. Conclusion. The SLICC inception cohort permits feasible construction of an FI for use in patients with SLE. Even in a relatively young cohort of patients with SLE, frailty was common. The SLICC-FI may be a useful tool for identifying patients with SLE who are most vulnerable to adverse outcomes, but validation of this index is required prior to its use.

UR - http://www.scopus.com/inward/record.url?scp=85077401794&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077401794&partnerID=8YFLogxK

U2 - 10.3899/jrheum.181338

DO - 10.3899/jrheum.181338

M3 - Article

C2 - 30988130

AN - SCOPUS:85077401794

SN - 0315-162X

VL - 47

SP - 72

EP - 81

JO - Journal of Rheumatology

JF - Journal of Rheumatology

IS - 1

ER -

Construction of a frailty index as a novel health measure in systemic lupus erythematosus

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