Oral Presentation ARA-NSW 2020 - 42nd Annual NSW Branch Meeting

Factors associated with an increased length of stay during an acute gout attack requiring hospitalisation (#38)

Cameron L Adams 1 , Kevin Pile 1 2 , Narainraj Kamalaraj 2
  1. Department of Rheumatology, Campbelltown & Camden Hospitals, Campbelltown, NSW, Australia
  2. School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia

INTRODUCTION:

The incidence of hospitalisations associated with an acute gout flare, either primary or secondary, is increasing, with 1.03 gout episodes per 1000 total hospital admissions.[1] The average length of stay (LOS) in Australian hospitals in 2013-2014, in patients with a primary diagnosis of gout was 1.66 days, and 7.04 in patients with a secondary diagnosis of gout, while other countries have ranges of 3-5 days.[1-3] Few studies have analysed factors associated with LOS in hospitalised gout patient and where they have, have mainly focused on patient related factors, rather than the severity of the gout flare itself.[2,4] Therefore, the aim of this study was to further investigate factors associated with an increased LOS in patients with an acute gout flare requiring hospitalisation.

METHODS:

A retrospective analysis of all patients admitted to our centre with a primary diagnosis of gout in 2019 was performed. Data extracted included the number of joints involved, C-reactive protein (CRP), uric acid levels, presence of tophi, pain scores on admission, age, comorbidities, presence of support people at home, and mobility impairments.

RESULTS:

A total of 75 separate admissions were identified from medical records, of which 62 were included in the analysis. The average LOS was 3.36 days. Analysis of correlation coefficients indicated higher joint counts, higher CRP levels, and impaired mobility, correlated with a longer LOS. A multiple linear regression model was developed using backwards elimination, in which impaired mobility and higher CRP levels remained significantly associated with a longer LOS, with a moderate effect size on the LOG(LOS) (R2 = 0.44) and respective coefficients of 0.44 (95% confidence interval: 0.22 to 0.61, p<0.0001), and 0.002 (95% confidence interval: 0.0012 to 0.0027, p<0.0001).

CONCLUSION:

Mobility impairment and higher CRP levels are associated with a longer LOS during acute gout attacks requiring hospital admission.

  1. Robinson PC, et al. Epidemiology of inpatient gout in Australia and New Zealand: temporal trends, comorbidities and gout flare site. International Journal of Rheumatic Diseases 2017;20(6):779-784
  2. Singh JA, Yu S. Gout-related inpatient utilization: a study of predictors of outcomes and time trends. Arthritis Research & Therapy. 2016;18(1):57–66.
  3. Dehlin M.I., Sigurdardottir V, Drivelegka P, Svard A, Jacobsson LT. Trends and costs for gout hospitalisation in Sweden. Annals of the Rheumatic Diseases. 2017;76(S2):164.
  4. Sharim R, Musselman M, Blum M. Factors associated with a prolonged hospital length of stay for patients with acute gout. Arthritis and Rheumatism. 2012;64(10):S772.