AB0109 COMORBIDITIES AND UNCONTROLLED SERUM URIC ACID PREDICTS ALL-CAUSE HOSPITALISATION IN PATIENTS WITH GOUT: RESULTS FROM MONOCENTRIC AUDIT IN GOUT PATIENTS
Authors: A. Adenitan, H. Sapkota
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Gout is the most prevalent non-autoimmune mediated inflammatory arthritis commonly encountered and managed by rheumatologists and general practitioners (GPs). The continuous increase in prevalence and incidence of gout and the potentially debilitating nature of acute flare can lead to recurrent hospitalisation and prolonged hospital stays. Prompt diagnosis, optimisation of uric acid-lowering agents via treat-to-target gout clinics and understanding the preventable factors that preclude an increase in admission rate are essential for adequate management of gout patients. <h3>Objectives:</h3> This study looked at predictors of all causes of hospitalisations among patients with gout, emphasising serum uric acid and comorbidities. It highlighted the treat-to-target approach and continuous synergy between rheumatologists and other doctors involved in managing patients with gout. <h3>Methods:</h3> This hospital-based retrospective study was conducted by conveniently sampling the information of patients diagnosed with gout between August 2020 and October 2023 on the integrated electronic health records. Of the 417 gout patients on the database, 399 were selected for the audit. The serum uric acid at diagnosis and present, comorbidities, presence of trophi, and other demographic features were collected. The number of hospital admissions for any cause was collated from electronic records. Multimorbidity was defined as two or more comorbidities in the same patient. Other comorbidity was defined as other conditions in the patient different from the defined comorbidities. Descriptive stats and binary logistic regression (adjusted for age, gender, ethnicity and covariates with p&lt;0.05 in univariate analysis were used) were performed. Data is represented as frequency (percentage) or median (IQR). Statistical Package for the Social Sciences (SPSS) version 26 was used for analysis, and statistical significance was defined as P-value &lt;0.05 (two-sided). <h3>Results:</h3> A total of 399 patients with gout [median (IQR) age of 67 (53-82) years and 77.2% males, 75.9% Caucasians] were analysed. Tophaceous gout at presentation was seen in 53 (13.2%). Serum Uric Acid (SUA) median (IQR) at diagnosis and present are 496 (452-577) and 471 (386-573), respectively. Two-thirds (64.9%) were on allopurinol, and nearly one-half (59.7%) were on less than a dose of 300 mg/day. 328 (82.2%) patients were hospitalised for any cause among them. Univariate analysis (Table 1) revealed a significant association between hospitalisation and current serum uric acid (SUA) levels (p&lt;0.05). Cardiac-related comorbidities, chronic kidney disease (CKD), multimorbidity, other comorbid conditions, and being on general practitioner (GP) follow-up also showed significant associations (p&lt;0.05). Binary logistic regression (Table 2) indicated SUA as a significant predictor of hospitalisation (p&lt;0.05). At the same time, other comorbidities had an odds ratio of 3.71 (95% CI 1.61-8.52), and tophaceous gout at presentation showed a protective effect with an odds ratio of 0.16 (95% CI 0.70-0.36). <h3>Conclusion:</h3> Multimorbidity and inadequate serum uric acid control predict hospital admission in gout patients. Implementing continuous education for GPs and non-rheumatology doctors and establishing multidisciplinary treat-to-target clinics led by physicians or nurses for better uric acid level management can reduce recurrent hospitalisations in gout patients. This approach is expected to be cost-effective in the long term. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> We appreciate the record department of New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, for providing the information requested promptly. <b>Ethics:</b> We adhere to the Helsinki Declaration. <h3>Disclosure of Interests:</h3> <b>None declared.</b>