Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index

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 R. Fortin; Dafna D. Gladman; Murray B. Urowitz; Ian N. Bruce; David A. Isenberg; Anisur Rahman; Graciela S. Alarcón; 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; Søren Jacobsen; Christine A. Peschken; Anca Askanase; John G. Hanly

doi:10.1002/acr.24504

Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index

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 R. Fortin, Dafna D. Gladman, Murray B. Urowitz, Ian N. Bruce, David A. Isenberg, Anisur Rahman, Graciela S. AlarcónMichelle 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, Søren Jacobsen, Christine A. Peschken, Anca Askanase, John G. Hanly

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Resumen

Objective: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. Methods: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics. Results: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13–1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02–1.16]). Conclusion: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

Idioma original	English
Páginas (desde-hasta)	638-647
Número de páginas	10
Publicación	Arthritis Care and Research
Volumen	74
N.º	4
DOI	https://doi.org/10.1002/acr.24504
Estado	Published - abr. 2022

Nota bibliográfica

Funding Information:
The Hopkins Lupus Cohort is supported by the NIH (grants AR43727 and 69572). The Montreal General Hospital Lupus Clinic is supported by the Singer Family Fund for Lupus Research. Dr. Rockwood's work was supported by the Canadian Institutes of Health Research, the Queen Elizabeth II Health Sciences Centre Foundation, the Capital Health Research Fund, and the Fountain Family Innovation Fund, and he is the Kathryn Allen Weldon Professor of Alzheimer Research from the Dalhousie Medical Research Foundation. Dr. Bae's work was supported by the Republic of Korea (NRF‐2017M3A9B4050335). Dr. Gordon's work was supported by Lupus UK, Sandwell, West Birmingham Hospitals NHS Trust, and the NIHR/Wellcome Trust Birmingham Clinical Research Facility. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin's work was supported by a Distinguished Senior Investigator award of The Arthritis Society, and he holds a Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval. Dr. Bruce's work was supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre, and the NIHR/Wellcome Trust Manchester Clinical Research Facility, and he is an NIHR Senior Investigator. Dr. Isenberg's and Dr. Rahman's work was supported by the NIHR, University College London Hospitals Biomedical Research Center. Dr. Dooley's work was supported by the NIH (grant RR00046). Dr. Ramsey‐Goldman's work was supported by the NIH (5UL1‐TR‐001422‐02 [formerly 8UL1‐TR‐000150], UL‐1RR‐025741, K24‐AR‐02318, and P60‐AR‐064464 [formerly P60‐AR‐48098]). Dr. Ruiz‐Irastorza's work was supported by the Department of Education, Universities, and Research of the Basque Government. Dr. Jacobsen's work was supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). Dr. Hanly's work was supported by the Canadian Institutes of Health Research (grant MOP‐88526).

Publisher Copyright:
© 2020 American College of Rheumatology

ASJC Scopus Subject Areas

Rheumatology

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

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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. R., Gladman, D. D., Urowitz, M. B., Bruce, I. N., Isenberg, D. A., Rahman, A., ... Hanly, J. G. (2022). Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index. Arthritis Care and Research, 74(4), 638-647. https://doi.org/10.1002/acr.24504

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, PR, Gladman, DD, Urowitz, MB, Bruce, IN, Isenberg, DA, Rahman, A, Alarcón, 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 2022, 'Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index', Arthritis Care and Research, vol. 74, n.º 4, pp. 638-647. https://doi.org/10.1002/acr.24504

@article{22ab7d22cf754530b8f0038b5ad1af12,

title = "Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index",

abstract = "Objective: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. Methods: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics. Results: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13–1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02–1.16]). Conclusion: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.",

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 Fortin, {Paul R.} and Gladman, {Dafna D.} and Urowitz, {Murray B.} and Bruce, {Ian N.} and Isenberg, {David A.} and Anisur Rahman and Alarc{\'o}n, {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 S{\o}ren Jacobsen and Peschken, {Christine A.} and Anca Askanase and Hanly, {John G.}",

note = "Funding Information: The Hopkins Lupus Cohort is supported by the NIH (grants AR43727 and 69572). The Montreal General Hospital Lupus Clinic is supported by the Singer Family Fund for Lupus Research. Dr. Rockwood's work was supported by the Canadian Institutes of Health Research, the Queen Elizabeth II Health Sciences Centre Foundation, the Capital Health Research Fund, and the Fountain Family Innovation Fund, and he is the Kathryn Allen Weldon Professor of Alzheimer Research from the Dalhousie Medical Research Foundation. Dr. Bae's work was supported by the Republic of Korea (NRF‐2017M3A9B4050335). Dr. Gordon's work was supported by Lupus UK, Sandwell, West Birmingham Hospitals NHS Trust, and the NIHR/Wellcome Trust Birmingham Clinical Research Facility. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin's work was supported by a Distinguished Senior Investigator award of The Arthritis Society, and he holds a Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Universit{\'e} Laval. Dr. Bruce's work was supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre, and the NIHR/Wellcome Trust Manchester Clinical Research Facility, and he is an NIHR Senior Investigator. Dr. Isenberg's and Dr. Rahman's work was supported by the NIHR, University College London Hospitals Biomedical Research Center. Dr. Dooley's work was supported by the NIH (grant RR00046). Dr. Ramsey‐Goldman's work was supported by the NIH (5UL1‐TR‐001422‐02 [formerly 8UL1‐TR‐000150], UL‐1RR‐025741, K24‐AR‐02318, and P60‐AR‐064464 [formerly P60‐AR‐48098]). Dr. Ruiz‐Irastorza's work was supported by the Department of Education, Universities, and Research of the Basque Government. Dr. Jacobsen's work was supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). Dr. Hanly's work was supported by the Canadian Institutes of Health Research (grant MOP‐88526). Publisher Copyright: {\textcopyright} 2020 American College of Rheumatology",

year = "2022",

month = apr,

doi = "10.1002/acr.24504",

language = "English",

volume = "74",

pages = "638--647",

journal = "Arthritis Care and Research",

issn = "2151-464X",

publisher = "John Wiley & Sons Inc.",

number = "4",

}

TY - JOUR

T1 - Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index

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 R.

AU - Gladman, Dafna D.

AU - Urowitz, Murray B.

AU - Bruce, Ian N.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Alarcón, 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, Søren

AU - Peschken, Christine A.

AU - Askanase, Anca

AU - Hanly, John G.

N1 - Funding Information: The Hopkins Lupus Cohort is supported by the NIH (grants AR43727 and 69572). The Montreal General Hospital Lupus Clinic is supported by the Singer Family Fund for Lupus Research. Dr. Rockwood's work was supported by the Canadian Institutes of Health Research, the Queen Elizabeth II Health Sciences Centre Foundation, the Capital Health Research Fund, and the Fountain Family Innovation Fund, and he is the Kathryn Allen Weldon Professor of Alzheimer Research from the Dalhousie Medical Research Foundation. Dr. Bae's work was supported by the Republic of Korea (NRF‐2017M3A9B4050335). Dr. Gordon's work was supported by Lupus UK, Sandwell, West Birmingham Hospitals NHS Trust, and the NIHR/Wellcome Trust Birmingham Clinical Research Facility. Dr. Clarke holds The Arthritis Society Chair in Rheumatic Diseases at the University of Calgary. Dr. Fortin's work was supported by a Distinguished Senior Investigator award of The Arthritis Society, and he holds a Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases at Université Laval. Dr. Bruce's work was supported by Arthritis Research UK, the NIHR Manchester Biomedical Centre, and the NIHR/Wellcome Trust Manchester Clinical Research Facility, and he is an NIHR Senior Investigator. Dr. Isenberg's and Dr. Rahman's work was supported by the NIHR, University College London Hospitals Biomedical Research Center. Dr. Dooley's work was supported by the NIH (grant RR00046). Dr. Ramsey‐Goldman's work was supported by the NIH (5UL1‐TR‐001422‐02 [formerly 8UL1‐TR‐000150], UL‐1RR‐025741, K24‐AR‐02318, and P60‐AR‐064464 [formerly P60‐AR‐48098]). Dr. Ruiz‐Irastorza's work was supported by the Department of Education, Universities, and Research of the Basque Government. Dr. Jacobsen's work was supported by the Danish Rheumatism Association (A3865) and the Novo Nordisk Foundation (A05990). Dr. Hanly's work was supported by the Canadian Institutes of Health Research (grant MOP‐88526). Publisher Copyright: © 2020 American College of Rheumatology

PY - 2022/4

Y1 - 2022/4

N2 - Objective: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. Methods: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics. Results: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13–1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02–1.16]). Conclusion: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

AB - Objective: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. Methods: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics. Results: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13–1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02–1.16]). Conclusion: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

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DO - 10.1002/acr.24504

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JO - Arthritis Care and Research

JF - Arthritis Care and Research

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ER -

Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index

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