The GOUT-36 prediction rule for inpatient gout flare in people with comorbid gout: derivation and external validation

Jatuworapruk, Kanon; Grainger, Rebecca; Dalbeth, Nicola; Lertnawapan, Ratchaya; Hanvivadhanakul, Punchong; Towiwat, Patapong; Shi, Lianjie; Taylor, William J.

doi:10.1093/rheumatology/keab590

Cited by 5 publications

(10 citation statements)

References 10 publications

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“…Risk stratification tools such as the GOUT-36 model established by Jatuworapruk et al . 12 have incorporated such risk factors and may be utilized to stratify patients at highest risk for inpatient gout flare.…”

Section: Discussionmentioning

confidence: 99%

Gout increases length of stay in patients hospitalized for heart failure exacerbation

DeMizio

Wei

et al. 2022

Therapeutic Advances in Musculoskeletal

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Background: It is unclear whether patients with a history of gout have longer hospitalizations in general, or only when suffering a flare. This study examines the effect of gout diagnosis and gout flare on the length of stay (LoS) in patients admitted for heart failure (HF) exacerbation. Methods: We conducted a matched retrospective cohort study and searched electronic medical records for patients admitted for HF with a prior diagnosis of gout from 1 July 2012 to 30 June 2017 and matched them to patients admitted for HF without gout. Cases who had a gout flare during the admission were identified. The log of the length of stay (log LoS) was utilized for normalization of the data. We used a linear mixed-effect model to compare the adjusted LoS of gout patient with flare, gout patient without flare, and controls. Results: A total of 978 admissions for HF exacerbation in 738 patients, including 246 individual with gout and 492 matched controls, were identified and included in the analysis. The log LoS was significantly longer in cases (1.86 ± 0.95) compared with controls (1.72 ± 0.94; p = 0.0278). The log LoS was significantly longer in those with gout who flared (2.41 ± 0.96) compared to those without gout (1.72 ± 0.94, p < 0.0001). After adjusting for potential confounders, the log LoS of patients who flared ( p < 0.0001) remained significantly longer than controls, as well as those who did not flare ( p = 0.042), but to a lesser extent. Conclusion: HF patients with gout had significantly longer hospitalizations than those without gout, a finding driven primarily by gout flare during hospitalization.

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Section: Discussionmentioning

confidence: 99%

Gout increases length of stay in patients hospitalized for heart failure exacerbation

DeMizio

Wei

et al. 2022

Therapeutic Advances in Musculoskeletal

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“…The identification of gout key words was done manually by research assistants who had been trained to look for gout key words in hospital discharge letters and had successfully performed similar manual search in another gout study. 3 Manual screening of discharge letters was necessary because some participants with inactive gout might not have received ICD-10 code for gout at their hospital discharge but gout would still have been mentioned as comorbidity in the letters.…”

Section: Patient Identificationmentioning

confidence: 99%

“…1 Gout flare is a common complication during hospitalization for medical illness or surgery, with prevalence between 14% and 34%. 2,3 Since inpatient gout flare can add up to six days to hospital length of stay it is important to better understand risk factors for gout flare during a hospital stay. 2 Previously, predictors of gout flare in the inpatient population with comorbid gout have been identified, and these include lack of pre-admission urate-lowering therapy (ULT), lack of preadmission gout flare prophylaxis, presence of tophus, and pre-admission serum urate above 6 mg/dL.…”

Section: Introductionmentioning

confidence: 99%

“…2 Previously, predictors of gout flare in the inpatient population with comorbid gout have been identified, and these include lack of pre-admission urate-lowering therapy (ULT), lack of preadmission gout flare prophylaxis, presence of tophus, and pre-admission serum urate above 6 mg/dL. 3 These factors form the components of the GOUT-36 prediction rule, a validated tool that can be completed at admission to help clinicians identify patients at risk of developing inpatient gout flare. 3 Over the last 2 years , coronovirus disease-19 (COVID-19) has been a major reason for hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…3 These factors form the components of the GOUT-36 prediction rule, a validated tool that can be completed at admission to help clinicians identify patients at risk of developing inpatient gout flare. 3 Over the last 2 years , coronovirus disease-19 (COVID-19) has been a major reason for hospitalization. Furthermore gout has been associated with increased odds of a COVID-19 diagnosis, as well as COVID-19-related death, most likely due to the high burden of comorbidities in gout population.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Risk Factors, and Outcomes of Gout Flare in Patients Hospitalized for PCR-Confirmed COVID-19: A Multicenter Retrospective Cohort Study

Jatuworapruk

Satpanich²,

Robinson³

et al. 2022

J Rheumatol

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ObjectiveThe study aimed to describe the prevalence and outcomes of gout flare in patients with comorbid gout hospitalized for COVID-19. Factors associated with gout flare, and hospital length of stay were explored.MethodsThis retrospective cohort study included adults with comorbid gout who were hospitalized for PCR-confirmed COVID-19 between March 2020 and December 2021 in three hospitals in Thailand. Prevalence, characteristics, and outcomes of gout flare were described. Factors associated with gout flare were explored using LASSO selection and multivariate logistic regression. Association between gout flare and hospital length of stay was explored using multivariate linear regression.ResultsAmong 8697 patients hospitalized for COVID-19, 146 patients with comorbid gout were identified and gout flare occurred in 26 (18%). Compared to those without flare, patients with gout flare had higher baseline serum urate and lower prevalence of use of urate-lowering therapy (ULT) and gout flare prophylaxis medications. One-third of gout flare episodes were treated with two or more anti-inflammatory medications. Logistic regression identified GOUT-36 rule ≥2, a predictive index for inpatient gout flare, as the only factor associated with gout flare (OR 5.46, 95%CI 1.18 to 25.37). Gout flare was found to be independently associated with hospital length of stay and added three days to hospital course.ConclusionGout flare occurred in 18% of patients with comorbid gout hospitalized for COVID-19 and added up to three days to hospital length of stay. Patients with suboptimal ULT appeared to be at high risk for gout flare during COVID-19 hospitalization.

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Serum Urate and Its Association With Gout Flares

Gaffo

2024

JAMA

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Gout is a chronic illness that has been underappreciated and poorly understood. Despite being more prevalent than rheumatoid arthritis and lupus, 1,2 gout has traditionally lagged behind these other diseases in research and quality of care. In addition, poor clinical management of gout is associated with increased cardiovascular morbidity and mortality, chronic kidney disease, and metabolic syndrome. These associations have been described as forming part of a comorbidity cluster in need of treatment optimization. 3 The intensely painful attacks of inflammatory arthritis known as gout flares are the main clinical manifestation of the disease, and their decrease in frequency and intensity is what matters most to patients. 4 Elevated serum urate levels above the saturation point (6.8 mg/dL at 37 °C, the definition of hyperuricemia) and the deposition of monosodium urate crystals in joints and periarticular tissues lead to activation of the innate immune system and the acute arthritis characteristic of gout. 5 Since the role of the uric acid molecule was recognized in the pathogenesis of gout, an association between circulating serum urate levels and clinical manifestations of gout was assumed. However, the evidence to support this assumption has been scarce. This issue became more controversial when the clinical guidelines for gout management were updated and were contradictory to the major rheumatology recommendations, which were still based on treating to a serum urate target using urate-lowering therapies. [6][7][8] Since then, concerns about the value of serum urate as a biomarker for gout severity and treatment response have increased, despite serum urate being used for decades for this purpose in the rheumatology practice community. Consequently, the need to generate evidence about the best strategy for secondary prevention of gout clinical manifestations is a priority.In this issue of JAMA, McCormick et al used data from the UK Biobank to study the association between a baseline level of serum urate and the subsequent risk of flares among 3613 patients with gout followed up for a mean of 8.3 years. 9 The primary analysis used a reference serum urate category of less than 6 mg/dL (the treat-to-target threshold recommended by most treatment guidelines) and studied the rate ratios of gout flares associated with 1.0-mg/dL increase categories over the reference value up to 10 mg/dL or higher. The results showed that all the categories above 6 mg/dL were associated with significantly increased rate ratios of gout flares, starting with 3.37 for the 6.0 to 6.9 mg/dL category up to 11.42 for the 10 mg/dL or higher category. These increased rate ratio associations did not vary meaningfully

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The GOUT-36 prediction rule for inpatient gout flare in people with comorbid gout: derivation and external validation

Cited by 5 publications

References 10 publications

Gout increases length of stay in patients hospitalized for heart failure exacerbation

Gout increases length of stay in patients hospitalized for heart failure exacerbation

Prevalence, Risk Factors, and Outcomes of Gout Flare in Patients Hospitalized for PCR-Confirmed COVID-19: A Multicenter Retrospective Cohort Study

Serum Urate and Its Association With Gout Flares

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