Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index

Alexandra Legge; Susan Kirkland; Kenneth Rockwood; Pantelis Andreou; Sang‐cheol Bae; Caroline Gordon; Juanita Romero‐diaz; Jorge Sanchez‐guerrero; Daniel J. Wallace; Sasha Bernatsky; Ann E. Clarke; Joan T. Merrill; Ellen M. Ginzler; Paul R. Fortin; Dafna D. Gladman; Murray B. Urowitz; Ian N. Bruce; David A. Isenberg; Anisur Rahman; Graciela S. Alarcón; Michelle Petri; Munther A. Khamashta; M. A. Dooley; Rosalind Ramsey‐goldman; Susan Manzi; Asad A. Zoma; Cynthia Aranow; Meggan Mackay; Guillermo Ruiz‐irastorza; S. Sam Lim; Murat Inanc; Ronald F. Vollenhoven; Andreas Jonsen; Ola Nived; Manuel Ramos‐casals; Diane L. Kamen; Kenneth C. Kalunian; Søren Jacobsen; Christine A. Peschken; Anca Askanase; John G. Hanly

doi:10.1002/acr.24504

Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index

Alexandra Legge, Susan Kirkland, Kenneth Rockwood, Pantelis Andreou, Sang‐cheol Bae, Caroline Gordon, Juanita Romero‐diaz, Jorge Sanchez‐guerrero, Daniel J. Wallace, Sasha Bernatsky, Ann E. Clarke, Joan T. Merrill, Ellen M. Ginzler, Paul R. Fortin, Dafna D. Gladman, Murray B. Urowitz, Ian N. Bruce, David A. Isenberg, Anisur Rahman, Graciela S. AlarcónMichelle Petri, Munther A. Khamashta, M. A. Dooley, Rosalind Ramsey‐goldman, Susan Manzi, Asad A. Zoma, Cynthia Aranow, Meggan Mackay, Guillermo Ruiz‐irastorza, S. Sam Lim, Murat Inanc, Ronald F. Vollenhoven, Andreas Jonsen, Ola Nived, Manuel Ramos‐casals, Diane L. Kamen, Kenneth C. Kalunian, Søren Jacobsen, Christine A. Peschken, Anca Askanase, John G. Hanly

Inflammation and Ageing

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Abstract

OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort.

METHODS: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics.

RESULTS: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13-1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02-1.16]).

CONCLUSION: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

Original language	English
Journal	Arthritis Care & Research
Early online date	5 Nov 2020
DOIs	https://doi.org/10.1002/acr.24504
Publication status	E-pub ahead of print - 5 Nov 2020

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LeggeA2020Prediction
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Legge, A., Kirkland, S., Rockwood, K., Andreou, P., Bae, S., Gordon, C., Romero‐diaz, J., Sanchez‐guerrero, J., Wallace, D. J., Bernatsky, S., Clarke, A. E., Merrill, J. T., Ginzler, E. M., Fortin, P. R., Gladman, D. D., Urowitz, M. B., Bruce, I. N., Isenberg, D. A., Rahman, A., ... Hanly, J. G. (2020). Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index. Arthritis Care & Research. Advance online publication. https://doi.org/10.1002/acr.24504

@article{0ffcd18e8da94474bddb361992f50003,

title = "Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index",

abstract = "OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort.METHODS: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics.RESULTS: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13-1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02-1.16]).CONCLUSION: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.",

author = "Alexandra Legge and Susan Kirkland and Kenneth Rockwood and Pantelis Andreou and Sang‐cheol Bae and Caroline Gordon and Juanita Romero‐diaz and Jorge Sanchez‐guerrero and Wallace, {Daniel J.} and Sasha Bernatsky and Clarke, {Ann E.} and Merrill, {Joan T.} and Ginzler, {Ellen M.} and Fortin, {Paul R.} and Gladman, {Dafna D.} and Urowitz, {Murray B.} and Bruce, {Ian N.} and Isenberg, {David A.} and Anisur Rahman and Alarc{\'o}n, {Graciela S.} and Michelle Petri and Khamashta, {Munther A.} and Dooley, {M. A.} and Rosalind Ramsey‐goldman and Susan Manzi and Zoma, {Asad A.} and Cynthia Aranow and Meggan Mackay and Guillermo Ruiz‐irastorza and Lim, {S. Sam} and Murat Inanc and Vollenhoven, {Ronald F.} and Andreas Jonsen and Ola Nived and Manuel Ramos‐casals and Kamen, {Diane L.} and Kalunian, {Kenneth C.} and S{\o}ren Jacobsen and Peschken, {Christine A.} and Anca Askanase and Hanly, {John G.}",

note = "{\textcopyright} 2020 American College of Rheumatology.",

year = "2020",

month = nov,

day = "5",

doi = "10.1002/acr.24504",

language = "English",

journal = "Arthritis Care & Research",

issn = "2151-464X",

publisher = "Wiley",

}

Legge, A, Kirkland, S, Rockwood, K, Andreou, P, Bae, S, Gordon, C, Romero‐diaz, J, Sanchez‐guerrero, J, Wallace, DJ, Bernatsky, S, Clarke, AE, Merrill, JT, Ginzler, EM, Fortin, PR, Gladman, DD, Urowitz, MB, Bruce, IN, Isenberg, DA, Rahman, A, Alarcón, GS, Petri, M, Khamashta, MA, Dooley, MA, Ramsey‐goldman, R, Manzi, S, Zoma, AA, Aranow, C, Mackay, M, Ruiz‐irastorza, G, Lim, SS, Inanc, M, Vollenhoven, RF, Jonsen, A, Nived, O, Ramos‐casals, M, Kamen, DL, Kalunian, KC, Jacobsen, S, Peschken, CA, Askanase, A & Hanly, JG 2020, 'Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index', Arthritis Care & Research. https://doi.org/10.1002/acr.24504

TY - JOUR

T1 - Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index

AU - Legge, Alexandra

AU - Kirkland, Susan

AU - Rockwood, Kenneth

AU - Andreou, Pantelis

AU - Bae, Sang‐cheol

AU - Gordon, Caroline

AU - Romero‐diaz, Juanita

AU - Sanchez‐guerrero, Jorge

AU - Wallace, Daniel J.

AU - Bernatsky, Sasha

AU - Clarke, Ann E.

AU - Merrill, Joan T.

AU - Ginzler, Ellen M.

AU - Fortin, Paul R.

AU - Gladman, Dafna D.

AU - Urowitz, Murray B.

AU - Bruce, Ian N.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Alarcón, Graciela S.

AU - Petri, Michelle

AU - Khamashta, Munther A.

AU - Dooley, M. A.

AU - Ramsey‐goldman, Rosalind

AU - Manzi, Susan

AU - Zoma, Asad A.

AU - Aranow, Cynthia

AU - Mackay, Meggan

AU - Ruiz‐irastorza, Guillermo

AU - Lim, S. Sam

AU - Inanc, Murat

AU - Vollenhoven, Ronald F.

AU - Jonsen, Andreas

AU - Nived, Ola

AU - Ramos‐casals, Manuel

AU - Kamen, Diane L.

AU - Kalunian, Kenneth C.

AU - Jacobsen, Søren

AU - Peschken, Christine A.

AU - Askanase, Anca

AU - Hanly, John G.

PY - 2020/11/5

Y1 - 2020/11/5

N2 - OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort.METHODS: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics.RESULTS: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13-1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02-1.16]).CONCLUSION: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

AB - OBJECTIVE: The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort.METHODS: Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics.RESULTS: The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5) at baseline. Mean ± SD baseline SLICC-FI was 0.17 ± 0.08. During mean ± SD follow-up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13-1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (relative rate 1.09 [95% CI 1.02-1.16]).CONCLUSION: The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.

U2 - 10.1002/acr.24504

DO - 10.1002/acr.24504

M3 - Article

C2 - 33152181

SN - 2151-464X

JO - Arthritis Care & Research

JF - Arthritis Care & Research

ER -

Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics frailty index

Abstract

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