Predictors of Mortality in People with Recent-onset Gout: A Prospective Observational Study
Zoë L Vincent1,2, Greg Gamble1,2, Meaghan House1,2
1From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
Insights
People with recent gout have a higher mortality risk. Subcutaneous tophi, a common gout symptom, independently predicts death from any cause, including cardiovascular events.
Area of Science:
- Rheumatology
- Epidemiology
- Public Health
Background:
- Gout is a common inflammatory arthritis characterized by hyperuricemia and urate crystal deposition.
- Recent-onset gout may indicate underlying systemic disease and increased mortality risk.
- Identifying mortality predictors in early gout is crucial for timely intervention.
Purpose of the Study:
- To determine mortality rates in individuals with recent-onset gout.
- To identify baseline predictors of all-cause mortality in this population.
Main Methods:
- Prospective cohort study of 295 participants with gout duration < 10 years.
- Baseline clinical assessments and follow-up for at least 1 year.
- Mortality data collected from health records; survival analysis using Cox regression.
Main Results:
- Aged 70-91 years, Māori or Pacific ethnicity, loop diuretic use, elevated serum creatinine, and subcutaneous tophi were associated with increased mortality.
- The standardized mortality ratio (SMR) was 1.96, indicating a nearly twofold increased risk of death.
- Subcutaneous tophi independently predicted both cardiovascular and non-cardiovascular mortality.
Conclusions:
- Individuals with recent-onset gout face elevated mortality risks.
- Subcutaneous tophi are a significant, independent predictor of mortality in gout patients.
- Early identification of risk factors like tophi is vital for managing gout and improving patient outcomes.
Objective:
To determine mortality rates and predictors of death at baseline in people with a recent onset of gout.
Methods:
People with gout disease duration < 10 years were recruited from primary and secondary care settings. Comprehensive clinical assessment was completed at baseline. Participants were prospectively followed for at least 1 year. Information about death was systematically collected from primary and secondary health records. Standardized mortality ratios (SMR) were calculated and risk factors for mortality were analyzed using Cox proportional hazard regression models.
Results:
The mean (SD) followup duration was 5.1 (1.6) years (a total 1511 patient-yrs accrued). Of the 295 participants, 43 (14.6%) had died at the time of censorship (SMR 1.96, 95% CI 1.44-2.62). In the reduced Cox proportional hazards model, these factors were independently associated with an increased risk of death from all causes: older age (70-80 yrs: HR 9.96, 95% CI 3.30-30.03; 80-91 yrs: HR 9.39, 95% CI 2.68-32.89), Māori or Pacific ethnicity (HR 2.48, 95% CI 1.17-5.29), loop diuretic use (HR 3.99, 95% CI 2.15-7.40), serum creatinine (per 10 µmol/l change; HR 1.04, 95% CI 1.00-1.07), and the presence of subcutaneous tophi (HR 2.85, 95% CI 1.49-5.44). The presence of subcutaneous tophi was the only baseline variable independently associated with both cardiovascular (CV) cause of death (HR 3.13, 95% CI 1.38-7.10) and non-CV cause of death (HR 3.48, 95% CI 1.25-9.63).
Conclusion:
People with gout disease duration < 10 years have an increased risk of death. The presence of subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.
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