MADRID, SPAIN — A far greater proportion of serious hospitalizations among patients with gout, as compared with age-matched patients in the general population, are related to cardiovascular (CV) and renal complications, according to research presented at the European Congress of Rheumatology, held June 12-15, 2019, in Madrid, Spain.

Gout, a disorder of uric acid metabolism, often presents as severe and acute joint pain. Citing their previous studies, the presenters suggested that all-cause hospitalizations in US patients with gout have increased by 410% in the past 22 years, which is almost 100-fold of the 4.8% increase in all-cause hospitalization rate for the United States in the same time period.

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The current study was designed to examine the reasons for these excess hospitalizations in 2016 by comparing the primary reasons for hospitalizations in US patients with gout compared with those in age-matched US patients without gout.   

Data for this study were taken from the Nationwide Inpatient Sample, a stratified random sample of all US community hospitals, and the only national US hospital database containing information on all patients, including uninsured persons and persons covered by Medicare, Medicaid, and private insurance.

Hospitalizations in 2016 among patients ≥40 years old with a primary or secondary gout diagnosis were compared with total all-cause hospitalization in patients without gout in the same age group during the same time period. More than 69,800 International Classification of Diseases, 10th revision codes were collapsed into a smaller number of clinically meaningful categories that are consistent with the Centers for Disease Control and Prevention clinical classification software, so that the top 15 primary hospitalization causes could be assessed and compared between the two study cohorts.

Among the 892,379 all-cause hospitalizations for US patients with gout, 1.6% (n = 14,135) of these were for a primary diagnosis of gout. The primary diagnoses for the remaining 878,244 hospitalizations in patients with gout were compared with the primary diagnoses in the 21.9 million hospitalizations among the general US population without gout.

The most common primary cause of hospitalization among both study cohorts was septicemia (7.8% in gout vs 7.4% in general population), but significant differences were seen in a number of other categories. Acute renal failure was twice as prevalent among patients with gout (4.5%; 39,455 hospitalizations) compared with the general population (2.1%; 458,920 hospitalizations); relative risk 2.11; 95% CI, 2.08-2.13; P <.0001).

Hospitalizations for “hypertensive complications and secondary hypertension” among patients with gout (4%; 35,435) were also higher compared with patients without gout (1.7%; 370,400); relative risk 2.35; 95% CI, 2.32-2.37; P <.0001). Hospitalizations because of gastrointestinal bleeding were 30% more prevalent among patients with gout, possibly associated with concomitant nonsteroidal anti-inflammatory drug treatment.

Study investigators concluded, “Among patients with gout, a far greater proportion of serious hospitalizations are related to renal and cardiovascular complications as compared to age-matched general population. This calls for an increased awareness and management of serious comorbid conditions in patients with gout.”

One study investigator reported connections to Acorda Therapeutics; Horizon Pharma; Merck & Co., Inc.; Pfizer, Inc.; Sancilio & Company, Inc.; UCB Pharma, Inc.; and UniPHARM Wholesale Drugs Ltd.

Reference

Singh G, Sehgal M, Mithal A. Gout in the US: significant associations with cardiovascular and renal disease hospitalizations. Presented at: Annual European Congress of Rheumatology; June 12-15, 2019; Madrid, Spain. Abstract SAT0446.