Prevalence of frailty and prefrailty in systemic lupus erythematosus: A systematic review and meta-analysis

Objective: Frailty is associated with mortality in systemic lupus erythematosus (SLE), but the prevalence is unclear. The aim of this systematic review and meta-analysis was to investigate the prevalence of frailty and prefrailty in SLE patients. Methods: Four databases, namely PubMed, Cochrane, EMBASE, and Web of Science, were systematically searched from their inception to November 2024 to identify studies that fulfilled the predefined a priori inclusion criteria for systematic review and meta-analysis, and that specifically investigated frailty and prefrailty in patients with SLE. The quality assessment of the included studies was conducted according to the Newcastle-Ottawa scale (NOS). Results: Fifteen studies were retrieved according to the inclusion criteria, and their data were combined in the eventual review. Data from studies including 46,060 patients with SLE were included. The analysis showed that the pooled prevalence of frailty in patients with SLE was 27 % (95 % CI: 19 % - 36 %), the pooled prevalence of prefrailty was 65 % (95 % CI: 54 % - 76 %). Analysis of subgroups revealed that the prevalence of frailty was 26 % (95 % CI: 14 % to 41 %) when measured by Systemic Lupus International Collaborating Clinics-Frailty Index (SLICC-FI) and 22 % (95 % CI: 18 % to 26 %) when assessed using Fried phenotype (FP). Conclusion: Both frailty and prefrailty are highly prevalent conditions among patients with SLE. There is an urgent need to better understand and address frailty in this population to enhance patient outcomes and quality of life.