Serious infection responsible for 1 in 10 gout hospitalizations
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Serious infections are responsible for 1 in 10 gout hospitalizations, with sepsis being the most common diagnosis among serious-infection hospitalizations for patients with gout, according to data published in Arthritis Care & Research.
“Gout is a common diagnosis in hospitalized patients,” Jasvinder A. Singh, MBBS, MPH, of the University of Alabama at Birmingham, told Healio Rheumatology. “Common causes of hospitalization include cardiac disease, renal disease and gout flares. A recent study in the United Kingdom drew attention to hospitalized infections as common diagnoses for gout hospitalizations. To our knowledge, U.S. data on serious infection hospitalizations in people with gout were lacking, a knowledge that our study attempts to fill.”
To examine the epidemiology of hospitalizations for serious infections among patients with gout, Singh and coauthor John D. Cleveland, MS, also from the University of Alabama at Birmingham, analyzed data from the U.S. National Inpatient Sample (NIS) from 1998-2014. According to the researchers, the NIS represents a 20% stratified sample of discharges in the United States, and is a component of the Healthcare Cost and Utilization Project.
The researchers used the data to identify patients with gout who were hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection, skin and soft tissue infections, or opportunistic infections. They then assessed the factors associated with health care use and mortality. Using weighted data, they observed 48,826,485 hospitalizations for serious infections among those without gout, and 1,140,085 among patients with gout.
According to the researchers, hospitalizations for serious infections constituted 11% of all hospitalizations among patients with gout. Compared with those without gout, patients with gout who were hospitalized for serious infections were older, with greater numbers of people demonstrating DeyoCharlson comorbidity scores of 2 or higher. Additionally, fewer were women or nonwhite. The most common infection was pneumonia, with 52% in 1998-2000, and sepsis, with 52% in 2015-2016.
Further, median hospital charges and hospital stays were greater for sepsis and opportunistic infections in 2015-2016, at $41,000 to $42,000 and 5.1 to 5.5 days, respectively, compared with urinary tract infection, pneumonia or skin and soft tissue infections, at $15,000 to $17,000 and 3 to 3.9 days, respectively.
Compared with sepsis, multivariable-adjusted odds of health care use and inhospital mortality were significantly lower in urinary tract infection, skin and soft tissue infections, and pneumonia. Nonhome discharge or inhospital mortality were lower in opportunistic infections. Among hospitalized infections, older age, Medicaid insurance, higher DeyoCharlson score, black race, and northeastern and nonrural hospital locations were associated with significantly higher health care use and mortality. Female sex, Medicare insurance and lower income were also associated with higher health care use.
“This study provides a contemporary analysis of the rates of key serious infections in hospitalized people with gout,” Singh said. “A knowledge of factors associated with health care utilization and mortality outcomes of serious infection hospitalizations in gout can inform patients and providers of risk factors and help in development of potential interventions for modifiable variables.”
Perspective
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Vickie L. Sayles, MHA, BSN, CRNI, RN-BC
Chronic gout can cause serious complications if left untreated. This common inflammatory arthritis has many of the same comorbidities and complications associated with rheumatoid arthritis so as rheumatology providers, we need to be stringent in our efforts to lower patients’ serum uric acid (sUA) to prevent long-term ill effects of the disease.
In the recent study by Singh and colleagues, the researchers found that among those hospitalized, the people with gout were older, mostly male and predominately white. These patients had a higher incidence of sepsis and pneumonia, resulting in the need for effective interventions to target their disease and reduce the financial burden associated with hospitalizations.
Since a high percentage of patients with gout have associated comorbidities — such as hypertension, chronic kidney disease, heart failure and stroke — it is imperative that clinicians recognize the need for aggressive sUA-lowering treatment before tophi and systemic damage occurs.
Clinicians should counsel patients about a low purine diet, limiting alcohol intake and sugary drinks, as well as avoiding certain medications which can exacerbate crystal formation. In addition, if patients present with significant tophi, aggressive treatment with sUA-lowering medications will help dissolve tophi and decrease the incidence of serious infections and hospitalizations associated with the disease.
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