Rate of Serious Infections in Gout on the Rise

The rate of serious infections in people with gout, especially sepsis and pneumonia, is increasing, and certain patient characteristics and external factors are associated with both higher healthcare use and in-hospital mortality in these patients, according to one of the first U.S. studies to describe the epidemiology of hospitalized serious infections in gout.

Hospitalizations related to gout, which is the most common inflammatory arthritis in adults and associated with increased morbidity and mortality, have increased and surpassed hospitalizations associated with rheumatoid arthritis. While serious infections contribute to gout hospitalizations, no comprehensive epidemiological studies of infection-related hospitalizations in gout in the United States have been undertaken.

In this study, Jasvinder A. Singh, M.B.B.S., M.P.H., and John D. Cleveland, M.S., used national sample data (1998-2016) to examine factors associated with utilization and mortality in people with gout hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection, skin and soft tissue infections, or opportunistic infections. The study was published in Arthritis Care & Research.

The study found that 11 percent of all hospitalizations in people with a non-primary diagnosis of gout were due to serious infection, increasing from 8.9 percent in 1998-2000 up to 14.5 percent in 2015-2016. The most common infection in people with gout in 1998-2000 was pneumonia and in 2015-2016 was sepsis. All five types of infection hospitalizations in people with gout increased over the study period, especially sepsis which increased 19.3-fold between the two time periods. In-hospital mortality was highest for sepsis at 10.1 percent, followed by opportunistic infections and pneumonia.

Compared to patients without gout, people with gout with hospitalized serious infections were a decade older, were more likely to have a Deyo‐Charlson comorbidity score ≥2 or have Medicare as the insurance payer and less likely to be female, findings the authors suggest may explain the higher hospital charges and longer stay in patients with gout.

In people with gout hospitalized with infections, older age, Medicaid insurance, higher Deyo-Charlson index score, being Black, and Northeast and non-rural hospital location were each independently associated with both higher healthcare use and in-hospital mortality. Female sex, lower income, and Medicare insurance payer type were associated with higher healthcare use.

“While some of these associations we noted are intuitive (older age, lower income, higher comorbidity), other associations (female sex, Black race, Medicare insurance payer; hospital characteristics) are new,” the authors wrote. “If our findings are replicated, these findings might allow the development of a prognostic score for predicting outcomes in people with gout hospitalized with these serious infections.”

REFERENCE

Jasvinder A. Singh,  John D. Cleveland. “Serious Infections in People with Gout in the United States: A National Study of Incidence, Time‐trends and Outcomes.”Arthritis Care & Research. April 5, 2020. DOI: https://doi.org/10.1002/acr.24201