Background/Purpose: The Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) was recently shown to predict mortality and damage accrual in the SLICC inception cohort. The objective of this study was to apply the SLICC-FI to a prevalent SLE cohort and assess the ability of the SLICC-FI to predict damage accrual among individuals with more longstanding SLE.

Methods: This was a secondary analysis of data from the Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE) cohort, which consists of adult women from the Chicago Lupus Database (age >18) who met at least 4 of the 1997 revised ACR classification criteria for definite SLE. A total of 185 SLE patients were enrolled, of which 149 patients were included in a 5-year follow up analysis. Baseline SLICC-FI was adapted based on available data in the SOLVABLE cohort, maintaining 46 health deficits for calculation of SLICC-FI scores. Damage accrual was defined as any increase of SLICC-Damage Index (SLICC-DI) at 5-year follow-up. Unadjusted and adjusted logistic regression models were conducted using baseline SLICC-FI (per 0.05 increase) to predict damage accrual.  

Results: Among the 149 patients with 5-year follow up data, mean (SD) age was 43.30 (10.15) years, mean (SD) disease duration was 11.93 (8.46) years, and mean (SD) SLICC-DI score was 1.64 (1.83) at baseline. The mean (SD) baseline SLICC-FI score was 0.18 (0.08) with a median (interquartile range) of 0.17 (0.10-0.23). At baseline, 36% (53 out of 149) of participants were categorized as frail, based on SLICC-FI values >0.21. About 40% of these patients (58 out of 149) had damage accrual at 5-year follow-up (minimum-maximum 1-11). In unadjusted analysis, each 0.05-unit increase in baseline SLICC-FI score was associated with a 28% higher odds of subsequent damage accrual (odds ratio [OR]=1.28, 95% CI 1.03-1.60).   In the adjusted model (adjusted for age, race, disease duration, and baseline SLICC-DI score), each 0.05-unit increase in baseline SLICC-FI score was associated with a 39% higher odds of subsequent damage accrual (OR=1.39, 95% CI 1.05, 1.85).  

Conclusion: In a prevalent SLE cohort, higher baseline SLICC-FI scores were associated with higher risk of subsequent damage accrual at 5-year follow up, after adjusting for age, race, disease duration, and baseline SLICC-DI scores. This demonstrates the utility of the SLICC-FI as a predictive tool for adverse outcomes among individuals with longstanding SLE.  

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-of-the-systemic-lupus-international-collaborating-clinics-frailty-index-slicc-fi-and-damage-accrual-in-long-standing-systemic-lupus-erythematosus/