910 - A Patient Reported Frailty Index That Can Predict Mortality Outcomes Among Patients with Arthritis

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Eswar Krishnan, Stanford University, Stanford, CA, James F. Fries, Stanford Univ Medical Center, Palo Alto, CA and Bharathi Lingala, Stanford
Presentation Number: 910

Background/Purpose: Physical Frailty, conceptually defined as loss of functional reserves at organ and organism level, is increasingly recognized as a state that is distinct from functional disability and contributes to adverse patient outcomes. There have been few studies that have examined the predictive power of Frailty in patients with arthritis.

Method: Utilizing the domain framework of physical Frailty from published literature, we constructed a simple five-item Patient reported (PRO)-Frailty Index using the following components- fatigue, poor balance, grip strength,  anorexia and memory loss. Using Cox regressions, we analyzed the utility of this Index to predict all-cause mortality in a cohort of 3,185 (78% women, mean age 64 years) patients with rheumatoid arthritis and osteoarthritis followed for a mean 4.3 years. Receiver Operating Curve (ROC) analyses were performed to identify the optimal cutoff that can be used to dichotomize the Frailty Index.

Result: The PRO-Frailty Index (range 0-5) had a near-normal distribution in the population studied with a mean (SD) of 1.3(1.1) overall. The PRO-Frailty Index predicted mortality in age-sex adjusted analyses with a hazard ratio  of 1.15(1.01-1.31) for each unit increase in PRO-frailty index. In multivariable analyses where the effect of age, gender, disease duration and education level were accounted for, each unit increase in PRO-Frailty Index was associated with 17% increased mortality risk (1.17; 1.02-1.34). ROC analyses suggested that dichotomizing the index at 0 and >0 offered the best model fit. The frailty-mortality  association was observed in both the arthritis categories although the confidence interval was too wide for statistical significance individually.

Conclusion: PRO-Frailty Index can predict mortality among patients with arthritis.

Keywords: outcome measures

Disclosure: E. Krishnan, None; J. F. Fries, None; B. Lingala, None.