Gout Flare in Hospitalized Patients: Risk Factors and the Impact of Allopurinol Management

Background Gout flares are a common and preventable complication among hospitalized patients. Changes in urate-lowering therapy, particularly allopurinol, may influence flare risk. Objective To evaluate risk factors for inpatient gout flares and the impact of allopurinol management during hospitalization. Methods This retrospective cohort study included 211 hospitalized patients with gout. Patients were categorized based on allopurinol exposure (continued, discontinued, resumed/initiated, or never used). The primary outcome was gout flare during hospitalization. Univariate and multivariable analyses were performed. Results Among 211 patients, 25 (11.8%) developed gout flares. Patients with flares had higher serum uric acid levels (10.1±2.3 vs. 9.1±2.0 mg/dL, p=0.03), higher prevalence of chronic kidney disease (52% vs. 35%, p=0.04), and greater diuretic use (36% vs. 18%, p=0.02). Allopurinol discontinuation (odds ratio (OR), 6.8; 95% confidence interval (CI), 2.8-16.5; p=0.001) and initiation/resumption (OR 5.9, 95% CI 2.1-16.8, p=0.002) were independently associated with increased flare risk. Conclusion In hospitalized patients, modification of allopurinol therapy is strongly associated with gout flares. Maintaining stable urate-lowering therapy may reduce preventable inpatient flares.