Effect of gout on 30-day survival in ICU patients: retrospective analysis of a large cohort of critically ill patients

Abstract

Background: Gout is a chronic disease caused by the deposition of sodium urate crystals, which is prone to multiple comorbidities, especially cardiovascular and kidney diseases. Patients with gout have higher all-cause and cause-specific mortality. However, it is unclear whether gout affects survival in ICU patients.

Methods: Data of the ICU patient cohort were obtained from the MIMIC IV database. The survival difference between the two groups was compared by Log-rank method. Cox regression was used to estimate the hazard ratio. Possible influencing factors were adjusted by matching. Quantitative variables were compared with Mann-Whitney/Wilcoxon test, and categorical variables were compared with Pearson's Chi-squared test.

Results: The 30-day survival rate of gout patients in ICU was 87.13%, significantly higher than 84.88% in matched controls (P = 0.009), with hazard ratio (HR) of 0.83 (95% CI: 0.73-0.96). HR was reduced to 0.74 (95% CI: 0.64-0.84) after adjusting Charlson comorbidity Index (CCI) and 0.72 (95% CI: 0.63-0.82) after adjusting sequential organ failure assessment (SOFA). HR rose to 0.86 (95% CI: 0.75-0.98) after matching the first diagnosis, but the difference was still statistically significant (P = 0.029). After grouping matching for sepsis, HR decreased slightly, to 0.80.

Conclusion: Gout showed a protective effect on 30-day survival in ICU patients, indicating that the understanding of gout deserves further exploration.

Keywords: 30-day mortality; Gout; Hyperuricemia; Intensive care unit; MIMIC-IV.

Fig. 1

The Kaplan-Meier curves before and after matching. (A) The Kaplan-Meier curve before matching. (B) The Kaplan-Meier curve after matching

Fig. 2

The effect of adjustment for confounding factors

Fig. 3

The Kaplan-Meier curves of patients treated with or without urico-lowering drugs