NEW research has demonstrated that frailty, a measure of biological age, predicts severe infections in older adults with incident antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, whilst chronological age is more closely linked to the risk of end-stage renal disease or death.
Researchers conducted a retrospective cohort study comparing the impact of frailty and age on outcomes such as end-stage renal disease, death, and severe infections in older adults with newly diagnosed ANCA-associated vasculitis. The study included individuals aged 65 years or older treated at Mass General Brigham between January 2002 and December 2019. A claims-based frailty index, derived from healthcare data in the year prior to treatment, was used to assess frailty. Individuals who lacked healthcare encounters during this period were classified as pre-frail. Incidence rates for end-stage renal disease, death, and severe infections were calculated for a 2-year period, and multivariable analyses were performed to explore the interaction between frailty and age on these outcomes.
A total of 234 individuals were included, 58% of whom were women, and 85% were White. Frailty was present in 22% of participants aged 65-74 and in 37% of those aged 75 years or older. Age 75 or older significantly increased the risk of end-stage renal disease or death (HR: 4.50; 95% CI: 1.83–11.09), while frailty alone did not (HR: 1.08; 95% CI: 0.50–2.36). Both age 75 or older (HR: 2.52, 95% CI: 1.26–5.04) and frailty (HR: 8.46; 95% CI: 3.95–18.14) were independent predictors of severe infections. Notably, frail individuals aged 65-74 had a higher incidence of end-stage renal disease or death than their non-frail counterparts (7.5 vs 2.0 cases per 100 person-years), but this trend did not hold for those aged 75 or older.
These findings suggest that frailty, more than age alone, predicts severe infection risk in older adults with ANCA-associated vasculitis, whereas age is a stronger predictor of renal outcomes and mortality. Future management strategies should incorporate assessments beyond just age, such as frailty, to improve clinical decision-making in older populations.
Reference
Sattui SE et al. The effects of age and frailty on the risks of end-stage renal disease, death, and severe infection in older adults with antineutrophil cytoplasmic antibody-associated vasculitis: a retrospective cohort study. Lancet Rheumatol. 2024;DOI:10.1016/S2665-9913(24)00193-0.
