Background/Purpose: Gout is the most common form of inflammatory arthropathy. It occurs due to urate crystal deposition within the joint space, usually in the setting of hyperuricemia. Gout has been associated with an increased risk of ischemic events including ischemic stroke and myocardial infarction (MI). The relationship between gout and ischemic colitis, the most common presentation of mesenteric ischemia, is not well-studied. We aim to use nationally available data to assess the associations between gout and ischemic colitis.

Methods: Patients with a diagnosis of ischemic colitis were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on presence of gout. Diagnoses were identified based on ICD-10 codes. Data were collected regarding incidence of shock, sepsis, peritonitis, bowel perforation, blood transfusion, intensive care unit (ICU) admission, and death. Other variables included age, gender, race, primary insurance, median income, hospital region, hospital bed size, length of stay (LOS), total hospitalization charges, and Charlson comorbidities. The relationship between outcomes in patients hospitalized with ischemic colitis and gout was analyzed using multivariate regression analysis.

Results: A total of 67,685 patients with a diagnosis of ischemic colitis were included in the study. Of these, 2,234 (3.3%) had a concurrent diagnosis of gout. Mean age in the gout group was 72.5 years compared to 67.6 years in the non-gout group. The majority of patients in the gout group were male (61.2%), White (72.9%), and had Medicare insurance (74.7%). Patients with gout had higher odds of developing ischemic colitis compared to those without (aOR 1.31, P < 0.001). On multivariate logistic regression analysis, presence of gout in patients with ischemic colitis was associated with a decreased risk of sepsis (aOR 0.75, P = 0.007), shock (aOR 0.67, P = 0.001), ICU admission (aOR 0.62, P = 0.001), and in-hospital mortality (aOR 0.61, P < 0.001). There was no difference in LOS between the two groups. Patients with gout had lower total hospitalization charges compared to those without ($122,507 vs $150,158). There was no difference in odds of bowel perforation, peritonitis, AKI, or blood transfusion between ischemic colitis patients with gout and those without.

Conclusion: Our study identified gout as a potential risk factor for developing ischemic colitis, which is consistent with previous literature identifying elevated risk of other ischemic events in patients with gout. However, our study found that presence of gout among hospitalized patients with ischemic colitis was associated with lower odds of sepsis, shock, ICU admission, and death. Gout may be a marker of better outcomes in patients with ischemic colitis, bringing about the question of antioxidative effects of uric acid playing a role. Further studies are needed to explore the underlying mechanisms of our findings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-associations-between-gout-and-ischemic-colitis-among-hospitalized-patients-a-retrospective-nationwide-analysis/