Friday, 23 Mar 2018

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Mortality in Gout Increased

Two current articles in the Journal of Rheumatology address issues surrounding mortality risk among those with new and established gout.

Vincent et al assessed predictors of mortality in patients with a recent onset of gout (disease duration < 10 years). They analyzed 295 patients with a mean followup duration of 5.1 years, during which time there were 43 deaths (14.6%).

Factors independently associated with an increased mortality risk included: older age (HR > 9.3 for those over 80 yrs.); Māori or Pacific ethnicity (HR 2.48); loop diuretic use (HR 3.99); elevated serum creatinine and the tophi (HR 2.85).  Amongst these only subcutaneous tophi was the only baseline variable independently associated with both CV death and all cause death.

A gout disease duration < 10 years has an increased risk of death. Subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.

Kang and Korean investigators also analyzed mortality risk in terms of gender and serum urate (SUA) levels. (Citation source:

During 12.3 years of followup there was 27,490 deaths, amounting to 6.9% of men and 3.1% of women died.

The bimodal (U shaped) association between SUA levels in men and mortality was not seen in women. Thus a significant interaction of gender was seen with the SUA-mortality association.

Thus a higher mortality rate was seen with very low SUA levels (SUA ≤ 4.0 mg/dl, adjusted HR 1.413) and higher SUA levels in men (> 8.0 mg/dl, adjusted HR 1.140). Women failed to show any significant association between SUA and mortality.

Novel to this study was the observation that lower SUA (after correction) was an independent risk factor for all-cause mortality in men with normal kidney function.

The author has no conflicts of interest to disclose related to this subject

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