Triglyceride-Glucose Index for predicting gout flare risk post-urate-lowering therapy: a prospective cohort study

Although urate-lowering therapy (ULT) is a cornerstone of gout management, some patients still experience recurrent gout flares. This study aimed to determine the predictive value of the triglyceride-glucose (TyG) index for the risk of gout flares in patients with gout after ULT.

A prospective cohort study enrolled 384 gout patients, stratified by baseline TyG index into high (≥9.0), moderate (8.5≤TyG index<9.0), and low (<8.5) groups. All received standardised ULT (febuxostat + low-dose colchicine) with 12-week follow-up to record target serum urate achievement and gout flare frequency.

A total of 362 patients completed the follow-up. The rate of achieving the target SU level (<6 mg/dL) at week 4 was significantly lower in the high TyG index group than in the low TyG index group (17.6% vs. 34.2%, p<0.01). No significant differences were observed among the three groups at week 8 or week 12 of achieving the target SU level. However, the high TyG index group had a significantly higher frequency of gout flares compared with the moderate and low TyG index groups (0.975 vs. 0.632 and 0.419, p<0.001).

The TyG index can serve as an effective predictor of gout flare risk after ULT, with those having a high TyG index exhibiting a higher risk, which might be related to the insulin resistance status. Incorporating the TyG index into routine clinical assessments may provide a novel metabolic strategy for personalised prevention and treatment of gout.