Background/Purpose: Frailty has been shown to predict damage accrual in patients with SLE, including those from Latin America. However, the impact of frailty on mortality has been scarcely evaluated, particularly in the Latin American population. The aim of this study was to evaluate frailty as a predictor of mortality in Latin American SLE patients.

Methods: The Almenara Lupus Cohort is a longitudinal study which was started in January 2012. The present study includes all patients in this cohort from its inception until the end of follow-up in March 2025. All patients met the ACR 1997 or the SLICC 2012 criteria set and were older than 18 years of age at baseline. Patients who had a diagnosis of other autoimmune disease except for Sjögren’s and the antiphospholipid syndromes were excluded. Mortality was defined as the vital status according to the official information from the Peruvian Department of Health. Frailty was ascertained using the SLICC-FI as a continuous variable. Univariable and multivariable Cox regression models were done to estimate the impact of the SLICC-FI on mortality. Multivariable model was adjusted for possible confounders (age at diagnosis, gender, socioeconomic status, years of education, ethnic group, tobacco use, disease duration, SLEDAI-2K, SLICC/ACR damage index, prednisone daily dose, antimalarial and immunosuppressive drugs use). Additionally, a Kaplan-Meier curve was calculated by frail status (frail: SLICC-FI > 0.21 and non-frail: SLICC-FI ≤ 0.21).

Results: Five-hundred and nine patients were included, 470 (92.3%) were women and 96 (18.9%) were frail. Their mean (SD) age at diagnosis was 35.0 (14.0) years, their disease duration at baseline was 6.7 (6.1) years and their mean follow- up time was 8.5 (4.1) years. Fifty-seven (11.2%) patients died during the follow-up. The SLICC-FI predicted mortality in the unadjusted and adjusted models, which are depicted in Table 1. The corresponding Kaplan-Meier curve is depicted in Figure 1 (log-rank: p< 0.001).

Conclusion: Frailty, as ascertained with the SLICC-FI, predicted mortality, even after adjustment by possible confounders, in a Latin American cohort of SLE patients. Additional research is needed to evaluate this association and its impact as a clinical outcome in SLE in different settings. Further strategies to improve frailty should be developed.

Table 1. Association between SLICC-FI and mortality risk. Unadjusted and adjusted analyses*

* Cox regression multivariable model was adjusted for age at diagnosis, gender, socioeconomic status, ethnic group, tobacco use, disease duration, SLEDAI-2K, SLICC/ACR damage index, prednisone daily dose, antimalarial and immunosuppressive drugs use.

SLICC-FI: Systemic Lupus International Collaborating Clinics Frailty Index; HR: Hazard ratio

Image 1. Survival by frail status

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-systemic-lupus-international-collaborating-clinics-frailty-index-slicc-fi-predicts-mortality-in-systemic-lupus-erythematosus-sle-patients-data-from-the-almenara-lupus-cohort/