Hyperuricemia and intravenous fat emulsion are risk factors for gout flares during active gastrointestinal bleeding: a case control study

Jiang, Yujie; Hong, Xuelian; Xia, Bingtian; Du, Hongwei

doi:10.1186/s42358-024-00376-w

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Sumário

Research • Adv. rheumatol. 64 • 2024 • https://doi.org/10.1186/s42358-024-00376-w copy

Hyperuricemia and intravenous fat emulsion are risk factors for gout flares during active gastrointestinal bleeding: a case control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

It is well-established that patients with a history of gout are more susceptible to experiencing gastrointestinal bleeding. Gout flare during active gastrointestinal bleeding poses a significant challenge due to the gastrointestinal side effects of anti-inflammatory therapy. This study sought to investigate the risk factors associated with gout flares during episodes of gastrointestinal bleeding.

Methods

We conducted a retrospective observational study involving 94 patients who experienced active gastrointestinal bleeding and had a history of gout. This study was conducted at Jinhua Municipal Central Hospital from January 2019 to October 2022. We collected and recorded demographic information and clinical characteristics.

Results

Among the gout flare patients, hyperuricemia and intravenous fat emulsion therapy were more prevalent compared to those who remained stable (81.6% vs. 57.8% and 46.9% vs. 24.4%, p < 0.05). Multivariate logistic regression analysis revealed that both hyperuricemia (odds ratio 2.741, 95% CI 1.014–7.413, p = 0.047) and intravenous fat emulsion therapy (odds ratio 2.645, 95% CI 1.046–6.686, p = 0.040) were independent predictors of gout flares. Furthermore, gout attacks occurred sooner in patients receiving intravenous fat emulsion therapy compared to those not receiving it (median: 4 days (interquartile range: 2) vs. median: 5 days (interquartile range: 2.25), p = 0.049).

Conclusion

Our study revealed a high incidence of gout flares during episodes of active gastrointestinal bleeding, with patients undergoing intravenous fat emulsion therapy and those with hyperuricemia being at increased risk.

Keywords
Gout flare; Gastrointestinal bleeding; Hyperuricemia; Intravenous fat emulsion

		Flare (n = 49)	Stable (n = 45)		P value
Gender (male)		46/49, 93.9%	43/45, 95.6%	X² = 0.000	>0.999
Age (years)		64.65 ± 12.93	67.67 ± 11.82	t = 1.176	0.243
Duration of gout > 10 years		23/49, 46.9%	24/45, 53.3%	X² = 0.384	0.536
Body Mass Index > 24.0 kg/m²		15/49, 30.6%	19/45, 42.2%	X² = 1.370	0.242
Comorbidity
	Hypertension	20/49, 40.8%	25/45, 55.6%	X² = 2.042	0.153
	Diabetes	7/49, 14.3%	6/45, 13.3%	X² = 0.018	0.894
	Coronary heart disease	7/49, 14.3%	7/45, 15.6%	X² = 0.030	0.863
	Cerebral infarction	2/49, 4.0%	3/45, 6.7%	X² = 0.010	0.922
	Heart failure	4/49, 8.2%	3/45, 6.7%	X² = 0.000	>0.999
	Renal insufficiency	25/49, 51.0%	21/45, 46.7%	X² = 0.178	0.673
Cirrhosis		10/49, 20.4%	11/45, 24.4%	X² = 0.220	0.639
Alcohol consumption		27/49, 55.1%	20/45, 44.4%	X² = 1.066	0.302
Serum uric acid (μmol/L)		535.00 (163.50)	487.82 ± 170.86	z = -1.582	0.114
Hyperuricemia		40/49, 81.6%	26/45, 57.8%	X² = 6.382	0.012
Urate-lowering therapy		4/49, 8.2%	6/45, 13.3%	X² = 0.228	0.633
Hemoglobin (g/L)		71 (20)	80.44 ± 18.43	Z = -1.045	0.296
Hemoglobin < 70 g/L		20/49, 40.8%	15/45, 33.3%	X² = -0.562	0.453
Diuretic		10/49, 20.4%	8/45, 17.8%	X² = 0.105	0.746
Causes of bleeding
	Peptic ulcer	26/49, 53.1%	23/45, 51.1%	X² = 1.094	0.296
	Esophageal variceal bleeding	7/49, 14.3%	7/45, 15.6%	X² = 0.030	0.863
	Others and unknown	16/49, 32.7%	15/45, 33.3%	X² = 0.005	0.944
Length of stay		10 (5)	8 (5)	Z = -2.279	0.023
Intravenous fat emulsion		23/49, 46.9%	11/45, 24.4%	X² = 5.141	0.023
Endoscopic procedure		36/49, 73.4%	32/45, 71.1%	X² = 0.065	0.798
Blood transfusion		30/49, 61.2%	19/45, 42.2%	X² = 3.394	0.065

Variables		n = 49
Day of hospitalization		4 (3)
Number of involved joint		2 (2)
Flare site
	Upper extremity	0 (1)	Z = -4.053	P < 0.001
	Lower extremity	1 (1)
Drugs
	Diclofenac diethylamine emulgel	44/49, 89.8%
	Colchicine	6/49, 12.2%
	Cyclooxygenase-2 inhibitor	7/49, 14.3%
	Glucocorticoids	18/49, 36.7%
	Diclofenac sodium suppositories	15/49, 30.6%

	OR	95% CI	P value	Adjusted OR	95% CI	P value
Hyperuricemia	3.248	1.276–8.267	0.013	2.741	1.014–7.413	0.047
Cirrhosis	0.793	0.300–2.095	0.639
Urate-lowering therapy	0.578	0.152–2.197	0.421	0.853	0.187–3.891	0.837
Diuretic	1.186	0.422–3.331	0.746
Intravenous fat emulsion	2.734	1.132–6.602	0.025	2.645	1.046–6.686	0.040
Endoscopic procedure	1.125	0.455–2.779	0.799	1.032	0.390–2.731	0.950
Alcohol consumption	1.534	0.680–3.462	0.303
Hemoglobin < 70 g/L	1.379	0.594–3.201	0.454
Transfusion	2.161	0.947–4.929	0.067	2.001	0.828–4.834	0.123

	Intravenous fat emulsion (n = 23)	Non-intravenous fat emulsion (n = 26)
Initiating intravenous fat emulsion day
Day 1	19
Day 2	3
Day 3	1
Time to Gout Flare (Days after Hospitalization)	4 (2)	5 (2.25)	Z = -1.968	0.049
Time to Gout Flare (Days after intravenous fat emulsion)	4 (3)
Number of involved joint	2 (2)	2 (2)	Z = -0.136	0.892
Flare site
Upper extremity	0 (1)	0 (1)	Z = -0.707	0.480
Lower extremity	2 (1)	1 (1)	Z = -0.656	0.512

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E-mail: rbreumatol@terra.com.br

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[1] *Correspondence: Hongwei Du duhongweifsk@sina.com