Khrais A, Kahlam A, Tahir A, Shaikh A, Ahlawat S. Outcomes of gout in patients with cirrhosis: A national inpatient sample-based study. World J Hepatol 2023; 15(2): 303-310 [PMID: 36926244 DOI: 10.4254/wjh.v15.i2.303]
Corresponding Author of This Article
Ayham Khrais, DO, Staff Physician, Division of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, United States. ak2017@njms.rutgers.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Feb 27, 2023; 15(2): 303-310 Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.303
Outcomes of gout in patients with cirrhosis: A national inpatient sample-based study
Ayham Khrais, Aaron Kahlam, Ali Tahir, Amjad Shaikh, Sushil Ahlawat
Ayham Khrais, Aaron Kahlam, Amjad Shaikh, Division of Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Ali Tahir, Division of Medicine, St. Luke’s University Health Network, Bethlehem, PA 18015, United States
Sushil Ahlawat, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Author contributions: All authors contributed to the study conception and design; Khrais A contributed to material preparation, data collection and analysis and wrote the first draft of the manuscript; Kahlam A and Tahir A and all authors commented on previous versions of the manuscript; Ahlawat S revised the article critically for important intellectual content; All authors read and approved the final manuscript.
Institutional review board statement: This study utilized de-identified data from a public database and as such was exempt from institutional review.
Informed consent statement: Informed consent was not required.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: Statistical code and database is available from the national inpatient sample at https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp. Consent was not obtained, but the presented data are anonymized, and risk of identification is non-existent as data were obtained from a public database.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ayham Khrais, DO, Staff Physician, Division of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, United States. ak2017@njms.rutgers.edu
Received: October 7, 2022 Peer-review started: October 7, 2022 First decision: January 3, 2023 Revised: January 6, 2023 Accepted: February 10, 2023 Article in press: February 10, 2023 Published online: February 27, 2023 Processing time: 140 Days and 13.3 Hours
Abstract
BACKGROUND
Hyperuricemia is a prerequisite for the development of gout. Elevated serum uric acid (UA) levels result from either overproduction or decreased excretion. A positive correlation between serum UA levels, cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established, but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes. We hypothesize that patients with cirrhosis will have poorer gout outcomes.
AIM
To explore the link between cirrhosis and the incidence of gout-related complications.
METHODS
This was a cross-sectional study. The national inpatient sample 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 codes. Primary outcomes were mortality, gout complications and joint interventions. The χ2 test and independent t-test were performed to assess categorical and continuous data, respectively. Multiple logistic regression was used to control for confounding variables.
RESULTS
Patients without cirrhosis were older (70.37 ± 13.53 years vs 66.21 ± 12.325 years; P < 0.05). Most patients were male (74.63% in the cirrhosis group vs 66.83%; adjusted P < 0.05). Patients with cirrhosis had greater rates of mortality (5.49% vs 2.03%; adjusted P < 0.05), gout flare (2.89% vs 2.77%; adjusted P < 0.05) and tophi (0.97% vs 0.75%; adjusted P = 0.677). Patients without cirrhosis had higher rates of arthrocentesis (2.45% vs 2.21%; adjusted P < 0.05) and joint injections (0.72% vs 0.52%; adjusted P < 0.05).
CONCLUSION
Gout complications were more common in cirrhosis. Those without cirrhosis had higher rates of interventions, possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.
Core Tip: Patients with cirrhosis had higher rates of gout-related complications including rates of flares. This could be due to the patients with cirrhosis having higher rates of hyperuricemia, predisposing them to worsening gout. Furthermore, patients with cirrhosis had lower rates of joint interventions, likely due to clinician hesitancy with performing such procedures due to an elevated risk of bleeding in patients with cirrhosis.
