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. 2024 Dec 20;8(1):71.
doi: 10.1186/s41927-024-00449-9.

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

Moses Yidong Lim  1 , Weixiang Lian  1 , Hwee Pin Phua  1 , Htet Lin Htun  2 , Kok Ooi Kong  3   4   5 , Ling Li Foo  6 , Teo Min-Li Claire  3 , Wei-Yen Lim  7   8
Affiliations

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

Moses Yidong Lim et al. BMC Rheumatol. .

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.

Keywords: Acute myocardial infarction; End-stage renal failure; Epidemiology; Gout; Serum urate; Stroke.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the hospital ethics review board (National Healthcare Group Domain Specific Review Board Ref 2019/00203). The requirement for informed consent was waived by the National Healthcare Group Domain Specific Review Board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Prior publications: An abstract of this paper was previously presented at the Singapore Health and Biomedical Congress, held in Singapore in October 2023, and at the Society for Epidemiologic Research Conference held in Portland, Oregon, United States of America in June 2023.

Figures

Fig. 1
Fig. 1
Flow diagram for selection of participants. #: Patients whose serum urate test done after 6 months from first diagnosis of gout were considered to have serum urate test done at baseline. ^: For inpatients, date of admission of the first gout episode. For outpatients, date of the first gout episode from diagnosis or medication
Fig. 2
Fig. 2
Group-based trajectory modelling of eligible individuals with gout
See this image and copyright information in PMC

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