Frailty associated with mortality in patients with lupus
WASHINGTON — Frailty — a syndrome of weight loss, weakness, slowness, exhaustion and inactivity — was associated with mortality, poor physical and cognitive function and overall functional decline in patients with systemic lupus erythematosus, according to findings presented at the American College of Rheumatology Annual Meeting.
“It does appear that frailty is something that might be a relevant concept in lupus, and it does predict declines in physical and cognitive functioning and a high risk of mortality,” Patricia P. Katz, PhD, professor of medicine at the University of California, San Francisco School of Medicine, said during her presentation. “The effects were not simply due to disease itself, because we saw these effects even after adjusting for disease activity and damage. The combination of frailty components appeared to create a combined risk for poor outcomes that was greater than any of the elements alone.”
Katz and colleagues performed an in-person research visit of 138 women with lupus between 2008 and 2009, and assessed the frailty components of weight loss, weakness, slowness, exhaustion and inactivity. The researchers determined slowness by a 4-meter walk using sex and height criteria. Weakness was determined by grip strength using sex and BMI criteria, and investigators determined both exhaustion and inactivity with a questionnaire. If the patient had a deficit in at least three of the five categories, researchers deemed the patient to be “frail.” Researchers considered a deficit in one or two categorizes to be “pre-frail” and a deficit in none of the categorized to be a “robust” patient. Of the patients, the mean age was 48 years; the mean lupus duration was 16 years; and 65% were white, non-Hispanic. Overall, 24% of patients were classified as frail and 48% were classified as pre-frail.
Researchers measured physical function with the SF-36 Physical Functioning subscale and the Valued Life Activities disability scale. They determined cognitive function using a 12-test battery, with scores below -1 standard deviation of age-adjusted population norms considered as impaired, and they determined mortality as of December 2015. Researchers calculated differences in function and 2-year changes in function using multiple regression analyses adjusted for factors such as age, lupus duration, glucocorticoid use, obesity, self-reported lupus activity and baseline function.
Researchers found frail women had significantly worse physical function compared with robust and pre-frail women. In addition, frail women were more likely to have cognitive impairment. The mortality rate was 16.7% in the frail group, 4.1% in the pre-frail group and 2.3% in the robust group. In the regression analysis, the frail group had an increased risk for death (risk ratio = 5.1).
“In terms of future directions, it may be important to try and develop a lupus-specific measure,” Katz said. “It may need to include different measures or additional factors.” – by Will Offit
Katz P, et al. Abstract #3051. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.
Disclosure: The researchers report no relevant financial disclosures.