Gout is the most common type of inflammatory arthritis in adults, and gout-related use of the emergency department or inpatient care has a significant cost burden, explains Jasvinder A. Singh, MBBS, MPH. “Studies show that the burden of gout-related hospitalization has increased over time and surpassed the hospitalization burden that has been previously seen with rheumatoid arthritis,” says Dr. Singh.

Patients with gout typically have significant comorbidities, which can lead to increased morbidity and mortality and may contribute to higher healthcare utilization. “It’s well known that gout typically afflicts elderly patients, but this is also a group that often has many risk factors for infection,” explains Dr. Singh. “Recent data show that rates of gout-related hospitalizations are increasing throughout the United States, but little attention has been given to the impact of these hospitalizations on patients with gout who have serious infections.”

 

Substantial Burden of Serious Infection

For a study published in Arthritis Care & Research, Dr. Singh and John D. Cleveland, MS, compared characteristics of patients hospitalized with serious infections with gout to those without gout in the US. The authors identified patients with gout who were hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), or opportunistic infections (OIs) in a US national inpatient sample from 1998-2016 and examined factors associated with healthcare utilization and mortality.

According to the findings, more than 1.1 million hospitalizations occurred over 19 years in patients with serious infections and gout, accounting for 11% of all hospitalizations for patients with a non-primary diagnosis of gout. In 1998–2000, the rate of serious infections in patients with gout was 8.9%, but this rate jumped to 14.5% in 2015–2016 (Figure).

Among patients with gout hospitalized with infections, several factors were associated with significantly higher healthcare utilization and mortality. These included older age, Medicaid coverage, the presence of more comorbidities, Black race, and Northeast and nonrural hospital locations. Female sex, Medicare insurance, and lower income were associated with higher healthcare utilization.

“The type of serious infections occurring in patients with gout have changed over time,” says Dr. Singh. In 1998–2000, the most common infection in patients with gout was pneumonia, but this switched over to sepsis by 2015-2016. Median hospital charges and hospital stays were higher for patients with sepsis and OIs in 2015-2016 than for those with UTIs, pneumonia, or SSTIs. Over the 20-year observation period, sepsis (36%) and pneumonia (34%) were the top two causes of serious infection hospitalizations in people with gout.

Results also showed that infection was among the top five reasons for hospitalizations in patients with gout. The frequencies of all five types of infection hospitalizations in people with gout increased significantly over the study period but were faster for sepsis and SSTIs than for the others. The in-hospital mortality rate for patients with gout was highest for those with sepsis (10.1%) and lowest for those who had SSTIs (0.5%).

 

Reducing the Burden of Serious Infections in People With Gout

“Our results give us a flavor of the incidence and impact of serious hospitalized infections in patients with gout,” says Dr. Singh. “The burden of serious infection is substantial in these patients with gout. Data from our study can inform clinicians about which hospitalized patients with gout are at greater risk for poor outcomes from serious infections and give healthcare professionals and care teams an idea about the prognosis for these individuals.”

Clinicians should keep a keen eye on the risk factors identified in the study when managing patients with gout, according to Dr. Singh. “Given the increasing rate of serious infections—especially sepsis and pneumonia—in people with gout, we need effective interventions to optimize care and outcomes for these patients,” he says. “Future interventions should target the factors associated with healthcare utilization and mortality. These efforts can help us improve patient outcomes and reduce the burden of serious infections in people with gout.”

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