Using the Concept of Frailty to Understand Variability in Health Outcomes Among Individuals with Systemic Lupus Erythematosus

Abstract

Some individuals experience greater susceptibility to adverse health outcomes than others, which is known as frailty. There are two main approaches to operationalizing frailty—the phenotypic approach and the deficit accumulation approach. We review these approaches and discuss their respective strengths and limitations. Both approaches can advance our understanding of the unexplained heterogeneity in health outcomes observed among individuals with systemic lupus erythematosus (SLE). A recent study using the frailty phenotype identified a higher than expected prevalence of frailty among women with SLE. Phenotypic frailty was associated with increased risk of subsequent functional decline and mortality. In a separate initiative, data from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort was used to construct a frailty index (FI) to measure deficit accumulation in SLE. FI scores in the SLICC inception cohort were higher than expected for similarly aged healthy individuals. Higher SLICC-FI values predicted increased risk of future organ damage accrual and mortality. Emerging evidence demonstrates that frailty is a useful concept for improving our understanding of the variability in health outcomes observed among individuals with SLE. Preventing and treating frailty in SLE may lead to reduced morbidity and mortality in this population.