Background/Purpose: Gout is the most prevalent inflammatory arthritis worldwide. Within the healthcare setting, gout flares contribute to substantial morbidity and complicated hospital stays. Identifying risk factors and preventing flares are mainstays of therapy. This case-case-control study aims at exploring the risk factors for developing an acute gout flare with special emphasis on inpatient stressors and gout attacks in the hospital setting.

Methods: This is a case-case-control study of all consecutive gout flares from January 2010 to January 2015. The first group of cases comprised patients who developed a gout exacerbation after 48 hours of admission to the hospital. The second group consisted of patients whose gout flare manifested within 48 hours of hospital admission. The control group included chronic gout patients that were hospitalized during the same time frame as cases but did not experience an acute gout attack during their stay. Two multivariable models were constructed, one including predictors of flare-up within hospitalized patients (>48 hrs), and the other including predictors for flare-up upon hospital admission (<48 hrs).

Results: A total of 530 patients were included in this study (184 gout cases >48 hrs of admission, 159 gout cases <48 hrs of admission, and 187 chronic gout controls). There were no significant differences in gender distribution, age means, length of stay, or Charlson comorbidity scores across all study groups. In the first multivariable model (gout attack>48 hrs of admission vs chronic gout controls), recent gastrointestinal bleeding (OR 3.0; CI 1.1-8.2), placement of a urinary catheter (OR 4.1; 95% CI 1.9-8.6), and antibiotic use >3 days (OR 3.2; 95% CI 1.4-7.5) constituted independent predictors of gout exacerbation within hospitalized patients. Subgroup antibiotic analysis revealed that inpatient gout exacerbations were associated with recent use of cephalosporins (p<0.001), quinolones (p=0.01), metronidazole (p=0.03), and vancomycin (p=0.001). In the second multivariable model, controls were more likely to have the following factors compared to cases: COPD (OR 1.89; 95% CI 1.1-3.3), rheumatoid arthritis (OR 4.2; 95% CI 1.2-15.3), recent infection (OR 2.2 95% CI 1.2-15.3), and a bedrest activity (OR 4.6 95% CI 1.7-12.6) order. In both models, Allopurinol (p<0.001) and Colchicine (p=0.003) use were significantly associated with chronic gout controls compared to cases.

Conclusion: Urinary catheter placement, antibiotic use, and gastrointestinal bleeding within 30 days seem to be unique predictors for gout flares within hospitalized patients. Prior use of cephalosporins (within 30 days) constituted an especially robust risk factor for an acute inpatient gout flare compared to controls. The design of this study permits for a more reliable assessment of inpatient risk factors compared to the classic case-control design.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-predictors-of-acute-gout-flares-within-hospitalized-patients-at-a-tertiary-care-center-in-new-york/