Outcomes of gout in patients with cirrhosis: A national inpatient sample-based study

doi:10.4254/wjh.v15.i2.303

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World Journal of Hepatology

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1948-5182

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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.

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

ARTICLE HIGHLIGHTS

Research background

Gout is an inflammatory joint disorder with increasing yearly incidence in the United States. It is affected by factors including diet, alcohol use and obesity, all of which are significant contributors to end stage liver disease. Furthermore, studies suggest a correlation between serum uric acid (UA) levels and cirrhosis.

Research motivation

The relationship between gout and cirrhosis and the possible relationship between hyperuricemia and liver disease has not been adequately explored, despite their common risk factors. We aimed to further clarify a possible link between the two disease states.

Research objectives

Our objective was to determine if patients with cirrhosis had differential rates of outcomes regarding hospitalizations for gout, including episodes of gout flares, disease complications and possible invasive interventions.

Research methods

We utilized data from the national inpatient sample, assessing inpatient cases from 2001 to 2013. Specifically, hospitalized individuals with gout were stratified based on the presence of cirrhosis. Outcomes of gout, including flares, tophus formation and joint interventions were explored. Rates of outcomes were compared between patients with and without cirrhosis.

Research results

We found that patients with cirrhosis had greater rates of gout flares, but lower rates of arthrocentesis and joint injections.

Research conclusions

Gout recurrence was more common in patients with cirrhosis, and joint interventions were performed more infrequently in these patients. The increased rate of gout flares could be secondary to elevated serum UA levels, as determined in prior research endeavors, in patients with cirrhosis. The reduced rate of joint interventions could be due to clinician hesitancy to perform these procedures, given the increased risk of bleeding in patients with cirrhosis.

Research perspectives

A link between cirrhosis and gout flares has been established, yet no significant difference was found between cirrhosis and other gout complications. Further prospective endeavors are required to further characterize this relationship.