Infection-related hospitalizations on the rise among people with gout
medwireNews: The rate of serious infections requiring hospitalization, particularly sepsis, is increasing among people with gout, US longitudinal study data show.
Jasvinder Singh and John Cleveland, both from the University of Alabama at Birmingham, used the US National Inpatient Sample (NIS) to identify people with gout who were hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infection (SSTI), or opportunistic infection between 1998 and 2016.
During this period there were 1,140,085 serious infections in these people, accounting for 11.0% of gout hospitalizations overall. Between 1998 and 2000 that proportion was 8.9%, increasing to 14.5% for the period 2015–2016.
More than half (52%) of the infections during 1998–2000 were due to pneumonia but by 2015–2016 the most common infection was sepsis (52%), which saw a 19.3-fold increase in the rates per 100,000 NIS claims from 1998 to 2016 By comparison, the NIS claim rates for UTI, SSTI, opportunistic infections, and pneumonia increased 14.9-, 3.5-, 2.6- and 2.2-fold, respectively, during the study period.
Sepsis also accounted for the highest in-hospital mortality rates, at 10.1%, followed by opportunistic infections (4.0%), pneumonia (3.1%), UTIs (0.6%), and finally SSTIs (0.5%).
But Singh and Cleveland note that in-hospital mortality rates decreased from 1998 to 2016 among people with sepsis (from 10.6% to 8.7%), pneumonia (4.0% to 2.8%), or an SSTI (0.7% to 0.4%), and remained stable for those with opportunistic infections (5.1% to 5.3%) or UTIs (0.6% to 0.6%).
After adjustment for potential confounders, the researchers found that the risk for in-hospital mortality was significantly lower among individuals with opportunistic infections (odds ratio [OR]=0.42), pneumonia (OR=0.28), UTIs (OR=0.05), and SSTIs (OR=0.05) than among those with sepsis.
The likelihood of being discharged to a care facility was also significantly lower among individuals with opportunistic infections, pneumonia, UTIs, and SSTIs (ORs=0.40–0.52) than among those with sepsis, while people with a UTI, SSTI, or pneumonia were less likely to have above median hospital charges (ORs=0.35–0.62) or hospital stays of longer than 3 days (ORs=0.36–0.61).
Further factors associated with significantly increased in-hospital mortality risk and healthcare utilization included older age, Medicaid use, higher comorbidity, Black race, and Northeast USA or non‐rural hospital location. Female sex, Medicare insurance, and lower income were associated with significantly higher healthcare utilization only.
Singh and Cleveland also found that compared with individuals hospitalized for serious infections with no gout during the study period, those with gout were older (median 74 vs 65 years), more likely to have a Deyo–Charlson comorbidity score of at least 2 (65 vs 42%), and less likely to be female (35 vs 53%) or non‐White (35% vs 40%).
Writing in Arthritis Care & Research, the authors conclude that their findings not only “allow a better understanding of the prognosis, but can also allow the development of individual level or systems-level interventions to improve outcomes of hospitalized serious infections in people with gout.”
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