Comparison of Metrics Used to Evaluate Frailty Among Women With SLE

According to study results published in Rheumatology, frailty was present in up to 26.9% of women with systemic lupus erythematosus (SLE), with patient characteristics differing according to the frailty metric utilized.  

Among adults of all ages with SLE, frailty has been associated with self-reported disability, organ damage, hospitalization, and mortality. Investigators compared frailty prevalence according to the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) or the Fried phenotype (FP) among women with SLE. They further evaluated whether self-reported disability differed between women with and without frailty according to each metric’s definition.

A cross-sectional analysis was conducted. Women aged from 18 to 70 years diagnosed with SLE who were seen at least twice during a 12-month period at the Hospital for Special Surgery in New York, NY, were included in the study. Patient Reported Outcome Measurement Information System (PROMIS) scores and physician-reported SLE disease activity and organ damage were recorded, in addition to frailty measurements.

A total of 67 women were included in the analysis. Participants self-identified as 33.8% Black, 31.0% White, 28.6% Hispanic or Latino, and 7.0% Asian.

A total of 18 women (26.9%) were identified as having frailty according to the SLICC-FI vs 12 women (17.9%) identified by the FP metric, with moderate agreement present between frailty metrics (kappa statistic, 0.41; P <.01).

According to either metric, women who were identified as having frailty vs those without had greater SLE disease damage (P <.01), worse PROMIS scores (P <.01), and greater prevalence of self-reported disability (P <.01). Frailty remained associated with greater odds for disability according to both metrics, following adjustment for age (odds ratio [OR] for SLICC-FI, 4.6; 95% CI, 1.3-15.8; OR for FP, 4.7; 95% CI, 1.2-18.8).

According to the SLICC-FI, women with vs without frailty had significantly greater SLE disease activity (P <.01) and a greater prevalence of active inflammatory arthritis (P =.02).

According to the FP metric, women with vs without frailty were older (P =.05), had a greater comorbidity burden (P <.01), and a greater prevalence of chronic kidney disease (P =.02).

Women with frailty according to either metric were associated with clinically and statistically worse PROMIS mobility, pain interference, pain behavior, and fatigue scores (all P <.01).

This study was limited by the underpowered sample size and exclusion of men and patients with high SLE disease activity.

“Frailty, regardless of the metric used, was associated with worse health outcomes in our sample of women with SLE, independent of age,” the study authors concluded.

“Further studies are needed to explore which metric is most informative in this population,” they added.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.