POS0147 ASSOCIATION OF FRAILTY WITH ADVERSE OUTCOMES IN SLE
Authors: N. Surmachevska, J. O ’connell, S. Krishfield, N. Cheng, V. Kyttaris, D. Misra
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Frailty is a geriatric syndrome of reduced physiologic reserve and vulnerability to adverse outcomes, such as infection, hospitalization, and mortality. Emerging evidence suggests an association of frailty with Systemic Lupus Erythematosus (SLE), but whether frailty contributes to adverse outcomes, such as infection, hospitalization, or emergency/urgent care visits, is unclear. <h3>Objectives:</h3> Our aim was to investigate the association of frailty and adverse outcomes in SLE using real world data. <h3>Methods:</h3> Study population included participants of the single site NIH-funded longitudinal lupus cohort in patients from Rheumatology clinic at our institution. We enrolled subjects who completed a cross-sectional survey assessing frailty (yes/no) using two standardized metrics: 1) Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI); and 2) FRAIL scale. SLICC-FI includes 48 measures of organ damage, active inflammation, comorbidities, function, mobility, health attitudes, and mental health. SLICC-FI scores range between 0 to 1, frailty is defined by score &gt;0.21 [1]. FRAIL scale includes 5 self-report measures, Fatigue, Resistance, Ambulation, Illnesses, Weight loss, each scored as 0 or 1. Frailty is defined by ≥3/5 score [2]. Demographic and clinical data collected included SLE disease activity (SLEDAI-2K), disease damage (SLICC-DI), and prednisone use (or steroid equivalent). Outcomes of interest were defined over the prior 3 months: 1) Infection requiring treatment (yes/no); and 2) Advanced level care (yes/no) i.e. hospitalization, emergency department, or urgent care visit. Descriptive analyses, univariate, and multivariate logistic regressions, adjusting for age, race, disease duration, SLEDAI-2K, SLICC-DI, current prednisone use, were performed in STATA 18.0. Sex was unadjusted for as the limited number of males in the sample did not have the outcomes of interest. <h3>Results:</h3> Among 83 survey respondents (77 women, mean age 42 years, 37% black, mean BMI 28.2 kg/m<sup>2</sup>, mean SLE duration 14.3 years, mean SLEDAI-2K 3.3, mean SLICC-DI 1.1, 51% history of lupus nephritis), 34.9% were with current prednisone use (mean dose 9.4 mg/d). Prevalence of frailty was 26.5% by SLICC-FI and 15.7% by FRAIL scale. The prevalence of infection requiring treatment was 9.6% and advanced level care was 20.5%. Univariate analysis found frailty by SLICC-FI was significantly associated with SLICC-DI (OR 1.61, 95%CI 1.08-2.40), and was not associated with age, race, disease duration, current prednisone use, or SLEDAI-2K. In univariate analysis, frailty by FRAIL scale was significantly associated with current prednisone use (OR 8.9, 95%CI 2.22-36.05), and was not associated with age, race, disease duration, SLEDAI-2K, or SLICC-DI. Frailty by SLICC-FI was significantly associated with infection in univariate (OR 5.7, 95%CI 1.23-26.26) and multivariate analyses (OR 7.29, 95%CI 1.21-43.99). Frailty defined by FRAIL scale had association with infection which approached significance in univariate (OR 3.9, 95%CI 0.80-18.90) and multivariate model (OR 6.6, 95%CI 0.70-63.36). Frailty by SLICC-FI was significantly associated with advanced level care in univariate analysis (OR 3.3, 95%CI 1.07-10.12) and approached significance in multivariate model (OR 4.6, 95%CI 0.98-21.65). Frailty by FRAIL scale had an association with advanced level care which approached significance in univariate (OR 3.02, 95%CI 0.85-10.85) and multivariate analyses (OR 5.25, 95%CI 0.75-36.59). Prednisone use was not associated with infection or advanced level care in our sample. <h3>Conclusion:</h3> Frailty measured by two metrics, SLICC-FI and FRAIL scale, is prevalent in SLE and is associated with infection and advanced level care (hospitalization, emergency department, and urgent care visits). Prednisone use alone was not associated with infection or advanced level care in our sample and suggests frailty may be an important independent factor contributing to adverse outcomes. <h3>REFERENCES:</h3> [1] Legge A, et al. 2020;47(1):72-81. [2] Morley J, et al. 2012;16(7):601-608. <h3>Acknowledgements:</h3> This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers. <h3>Disclosure of Interests:</h3> Natalya Surmachevska: None declared, Julianne O'Connell: None declared, Suzanne Krishfield: None declared, Nathan Cheng: None declared, Vasileios Kyttaris Consultant - Astra Zeneca. Advisory Boards - Fresenius Kabi, Janssen., Devyani Misra: None declared.