Hospitalization associated with increased gout flare risk
medwireNews: Admission to hospital is associated with a 10-fold increased risk for flare among patients with gout, study results suggest.
As reported in The Journal of Rheumatology, Cynthia Crowson (Mayo Clinic, Rochester, Minnesota, USA) and colleagues analyzed inpatient and outpatient medical records from 429 gout patients over two time periods (1989–1992 and 2009–2010).
In all, 169 patients experienced 454 hospital admissions over approximately 5 years of follow-up, most commonly due to cardiovascular disease, which accounted for around a quarter of admissions in both cohorts. Other reasons for hospitalization included infection, trauma, and gastrointestinal, pulmonary, or renal disease.
The rate of gout flare among hospitalized patients – defined as new-onset inflammatory arthritis attributed to gout – was 85.0 per 100 patient–years, compared with just 8.5 per 100 patient–years for nonhospitalized patients, a significant 10-fold risk increase.
Moreover, hospitalized patients who experienced gout flares were in hospital for an average of 1.8 days longer than those who did not have flares, in accordance with previously reported findings.
“The significantly prolonged hospitalization in patients who experience gout flare after admission warrant[s] further studies to identify strategies to mitigate this risk and possibly reduce attendant costs,” write the researchers.
They note that the overall rate of hospitalization “increased marginally” between 1989–1992 and 2009–2010 after accounting for multiple hospitalizations per patient, with corresponding rates of 2.26 and 2.69 per 10 patient–years, which they suggest could be due to an increasing number of comorbidities among gout patients.
Rates of in-hospital gout flares also increased over time, at 6.3 per 10 patient–years in 1989–1992 and 11.7 per 10 patient–years in 2009–2010, but the difference did not reach statistical significance.
Crowson and colleagues investigated a number of potential predictors of gout flare during hospitalization, including urate-lowering therapy discontinuation, diuretic use, admission to intensive care, and previous number of flares, but none were significantly associated with flare risk.
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