Which factors predict hospitalization for acute gout?

Several factors, including older age, overnight emergency department (ED) arrival time, higher serum urate (SU), higher C-reactive protein (CRP), and higher total white cell count at presentation, predict hospitalization for acute gout, according to a study.

A group of researchers analysed ED attendances and hospital admissions at two UK-based hospitals between 1 January 2017 and 31 December 2020. Using logistic regression and survival models, they identified demographic and clinical predictors of ED disposition (admission or discharge) and reattendance for gout flares, respectively.

In addition, the researchers performed case note reviews (n=59), stakeholder meetings, and process mapping to capture detailed information on gout management and identify strategies to improve care.

A total of 1,220 ED attendances for gout flares were recorded, of which 23.5 percent required hospitalization (median length of stay, 3.6 days). During the study period, 10.4 percent of patients had recurrent attendances for flares.

Multivariate analysis revealed the following predictors of admission to ED: older age, higher SU, higher CRP, overnight ED arrival time, and higher total white cell count at presentation. In detailed case note reviews, only 22.6 percent of patients with pre-existing gout were taking urate-lowering therapy (ULT) at presentation.

Initial diagnostic uncertainty occurred frequently, but rheumatology input and synovial aspirates were rarely obtained. Less than half of the patients (43.6 percent) were receiving ULT by 6 months postdischarge, but few had treat-to-target dose optimization, and only 9.1 percent achieved SU levels ≤360 μmol/L.

“Treat-to-target optimization of ULT following hospitalization remains inadequate and must be improved if admissions are to be prevented,” the researchers said.