Rutgers New Jersey Medical School West Orange, New Jersey
Introduction: Hyperuricemia is a prerequisite for the development of gout. Elevated serum uric acid (UA) levels result from either overproduction or decreased excretion (whether by the kidneys or bowel). Some literary works denote a positive correlation between serum UA levels, cirrhosis-related complications and the incidence of non-alcoholic fatty liver disease. The exact relationship, whether hyperuricemia results in worsening cirrhosis outcomes or vice versa, is unknown. Despite these correlations, few studies explore the relationship between cirrhosis and gout. We aim to explore a possible link between them.
Methods: The National Inpatient Sample (NIS) was used to identify patients hospitalized with gout, stratified based on a history of cirrhosis, from 2001 to 2013 via the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes. Primary outcomes consisted of mortality, gout complications (rates of flare, tophi formation, nephrolithiasis, nephropathy, and septic arthritis), and joint interventions (arthrocentesis and joint injection). Chi-squared and independent t-tests were done to assess categorical and continuous data, respectively. Multiple logistic regression was used to control for confounders, including age, sex at birth, race, cardiac arrhythmias, chronic pulmonary disease, heart failure, diabetes, HIV, HTN, peripheral vascular disease, alcohol use disorder and renal failure.
Results: Patients without cirrhosis were older (70.37±13.53 years versus 66.21±12.325 years; p< 0.05). The majority of both groups were male, but cirrhotic patients had more males versus females (74.63% versus 66.83%; adjusted p=0.121). Cirrhotic patients had higher rates of mortality (5.49% versus 2.03%; adjusted p< 0.05), gout flare (2.89% versus 2.77%; adjusted p< 0.05) and tophi (0.97% versus 0.75%; adjusted p=0.677). Non-cirrhotic patients had higher rates of arthrocentesis (2.45% versus 2.21%; adjusted p< 0.05) and joint injections (0.72% versus 0.52%; adjusted p< 0.05). Rates of septic arthritis, nephropathy and uric acid nephrolithiasis did not differ significantly among both groups.
Discussion: Cirrhotics had greater incidence of gout-related complications, representing a possible link between cirrhosis and elevated average serum UA levels. Non-cirrhotics had higher rates of more invasive interventions, which could be due to clinician hesitancy with performing these interventions given increased bleeding risk in the setting of cirrhosis-related coagulopathy.
