Novel frailty index predicts adverse health outcomes in longstanding SLE
medwireNews: An external validation study suggests that the novel Systemic Lupus International Collaborating Clinics frailty index (SLICC-FI) predicts organ damage accrual and mortality risk in patients with longstanding systemic lupus erythematosus (SLE).
The researchers explain that patients are assigned an SLICC-FI score out of 48, based on 48 health deficits, such as diabetes, coronary heart disease, and malignancy, being absent (0 points) or present (1 point). The index was initially tested in an inception cohort of patients with recently diagnosed SLE and successfully predicted the risk for hospitalization, organ damage accrual, and mortality.
“Building upon previous findings in the SLICC inception cohort, our study shows that SLICC-FI values can also predict organ damage accrual and mortality risk among individuals with more longstanding SLE,” say the study investigators.
To determine the validity of the index to predict future mortality risk and organ damage accrual in patients with longstanding SLE, the team calculated baseline SLICC-Fi scores for 183 patients with a median disease duration of 12.4 years. The patients had a median score of 0.17 and 29.5% were classified as frail due to having scores higher than 0.21.
During a mean 11-year follow-up 32 patients died, and those who were classified as frail at baseline were significantly more likely to die than those who were not, at a hazard ratio of 3.92.
Furthermore, in a multivariable analysis, the risk for death increased by a significant 18% with each 0.05-point increase in SLICC-FI score, after adjustment for factors including age, sex, corticosteroid use, education, disease duration, baseline damage, and smoking status.
To determine organ damage accrual over time, the researchers excluded organ damage-related health deficits from the total score (final score out of 32) and found that patients’ risk increased a significant 11% with each 0.05-point increase in SLICC-FI score, after adjusting for confounding variables.
“The generalizability of the FI is one of its major strengths, as it has demonstrated remarkably consistent properties when applied across diverse populations and settings,” write John Hanly (Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada) and co-authors.
They therefore conclude in Rheumatology that “the SLICC-FI can be applied to other existing SLE registries and clinical cohorts without requiring additional data collection, and without requiring construction of a new FI for each individual dataset. In the future, electronic medical records may be a useful implementation strategy for the prospective use of the SLICC-FI in clinical practice.”
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