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LSO-033 Comparison of the systemic lupus international collaborating clinics frailty index (SLICC-FI) and the FRAIL scale for identifying frailty among individuals with systemic lupus erythematosus
  1. Alexandra Legge1,
  2. Sarah Lieber2 and
  3. John Hanly1
  1. 1Medicine (Rheumatology), Dalhousie University, Canada
  2. 2Medicine (Rheumatology), Hospital for Special Surgery and Weill Cornell Medicine, USA


Background Frailty is associated with adverse health outcomes in systemic lupus erythematosus (SLE). We aimed to assess the agreement between two frailty measures, the SLICC Frailty Index (SLICC-FI) and the FRAIL scale, for identifying frailty among SLE patients. We also evaluated differences in characteristics between frail and non-frail SLE patients according to each frailty definition.

Methods This was a cross-sectional study of consecutive adult SLE patients assessed in the Lupus Clinic at a single academic medical centre from December 2020-November 2021. At a single visit, participants were assessed for disease activity, organ damage, comorbidities, medications, and health-related quality of life (HRQoL). A SLICC-FI score was calculated for each patient. The 5-item FRAIL scale was administered at the same visit. Agreement between the SLICC-FI and the FRAIL scale was evaluated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold SLICC-FI value based on agreement with the FRAIL scale.

Results The 181 SLE patients were mostly female (90.1%) with mean (SD) age 54.6 (14.3) years. Mean (SD) baseline SLICC-FI score was 0.17 (0.08), with 57 patients (31.5%) classified as frail (SLICC-FI >0.21). Based on the FRAIL scale, 31 patients (17.1%) were classified as frail (≥3/5 items). There was moderate correlation between the FRAIL scale and the SLICC-FI (r=0.639; p<0.0001). Agreement occurred in 84.5% of cases (κ=0.591; p<0.0001). The ROC curve analysis yielded an AUC of 0.936 (figure 1). The existing SLICC-FI cut-off value of >0.21 was the optimal threshold (sensitivity 96.8%, specificity 82%). For both frailty definitions, there were significant differences between frail and non-frail SLE patients in terms of age, education, employment status, organ damage, HRQoL, CRP levels, and ESR values (table 1).

Conclusions There is moderate agreement between the SLICC-FI and the FRAIL scale for identifying frailty in SLE patients. Each frailty metric may have distinct advantages in different settings.

Abstract LSO-033 Figure 1

Receiver operating characteristic (ROC) curve for SLICC frailty index (SLICC-FI) values, based on agreement with frailty status as determined by the FRAIL scale

Abstract LSO-033 Table 1

Clinical and laboratory characteristics of SLE patients based on frailty status (n=181)

  • Frailty
  • Outcome measures

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