BMC Rheumatology (Dec 2024)

Association between serum urate levels and all-cause mortality, cardiovascular and renal outcomes among gout patients in Singapore

  • Moses Yidong Lim,
  • Weixiang Lian,
  • Hwee Pin Phua,
  • Htet Lin Htun,
  • Kok Ooi Kong,
  • Ling Li Foo,
  • Teo Min-Li Claire,
  • Wei-Yen Lim

DOI
https://doi.org/10.1186/s41927-024-00449-9
Journal volume & issue
Vol. 8, no. 1
pp. 1 – 9

Abstract

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Abstract Objectives We investigated the longitudinal association between Serum Urate (SU) level and Acute Myocardial Infarction (AMI), Stroke, End Stage Renal Failure (ESRF) and all-cause mortality. Design We conducted a retrospective hospital-based cohort study of individuals with gout managed in specialist outpatient clinics. Cox proportional hazards regression was used to estimate HR and 95% CI, with adjustments for potential confounders. Where the proportional hazard assumption was violated, stratified Cox regression was applied instead. Setting An acute care tertiary hospital in Singapore. Participants Individuals with a first gout diagnosis between 2007–2017, identified through (i) primary discharge diagnosis, (ii) diagnosis from the Rheumatology SOC (iii) patient history of a clinical encounter at the Rheumatology SOC plus use of urate-lowering therapy/colchicine. Main outcome measures All-cause mortality, AMI, Stroke and ESRF ascertained through data linkage with the National Registry of Diseases Office. Results The final cohort comprised 2,866 individuals. Post follow-up, there were 800 deaths and 362, 218 and 191 occurrences of AMI, ESRF and stroke respectively. Compared to the reference (second-lowest) SU quartile, being in the highest SU quartile was associated with a significantly increased hazard for mortality (HR:1.66, 95% CI:1.36–2.03), incident ESRF (HR:3.02, 95% CI:2.00-4.56), and increased hazard for incident AMI (HR:1.42, 95% CI:1.06–1.91). The p-trend for all 3 outcomes was significant. No significant association was found between SU quartile and hazard for incident stroke. Conclusions This study found that individuals with gout managed at SOC who had higher baseline SU levels had an increased hazard for all-cause mortality, ESRF, and AMI. Clinical trial number Not applicable.

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