Vincent Zoë L, Gamble Greg, House Meaghan, Knight Julie, Horne Anne, Taylor William J, Dalbeth Nicola
From the Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland; Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
Z.L. Vincent, PhD, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; G. Gamble, MSc, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; M. House, MPH, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; J. Knight, BA, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; A. Horne, MBChB, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland; W.J. Taylor, PhD, FRACP, Department of Medicine, University of Otago Wellington; N. Dalbeth, MD, FRACP, Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland.
J Rheumatol. 2017 Mar;44(3):368-373. doi: 10.3899/jrheum.160596. Epub 2016 Dec 15.
To determine mortality rates and predictors of death at baseline in people with a recent onset of gout.
People with gout disease duration < 10 years were recruited from primary and secondary care settings. Comprehensive clinical assessment was completed at baseline. Participants were prospectively followed for at least 1 year. Information about death was systematically collected from primary and secondary health records. Standardized mortality ratios (SMR) were calculated and risk factors for mortality were analyzed using Cox proportional hazard regression models.
The mean (SD) followup duration was 5.1 (1.6) years (a total 1511 patient-yrs accrued). Of the 295 participants, 43 (14.6%) had died at the time of censorship (SMR 1.96, 95% CI 1.44-2.62). In the reduced Cox proportional hazards model, these factors were independently associated with an increased risk of death from all causes: older age (70-80 yrs: HR 9.96, 95% CI 3.30-30.03; 80-91 yrs: HR 9.39, 95% CI 2.68-32.89), Māori or Pacific ethnicity (HR 2.48, 95% CI 1.17-5.29), loop diuretic use (HR 3.99, 95% CI 2.15-7.40), serum creatinine (per 10 mol/l change; HR 1.04, 95% CI 1.00-1.07), and the presence of subcutaneous tophi (HR 2.85, 95% CI 1.49-5.44). The presence of subcutaneous tophi was the only baseline variable independently associated with both cardiovascular (CV) cause of death (HR 3.13, 95% CI 1.38-7.10) and non-CV cause of death (HR 3.48, 95% CI 1.25-9.63).
People with gout disease duration < 10 years have an increased risk of death. The presence of subcutaneous tophi at baseline is an independent predictor of mortality, from both CV and non-CV causes.
确定近期痛风发作患者基线时的死亡率及死亡预测因素。
从初级和二级医疗机构招募痛风病程<10年的患者。在基线时完成全面的临床评估。对参与者进行至少1年的前瞻性随访。从初级和二级健康记录中系统收集死亡信息。计算标准化死亡率（SMR），并使用Cox比例风险回归模型分析死亡的危险因素。
平均（标准差）随访时间为5.1（1.6）年（共积累1511患者年）。在295名参与者中，43名（14.6%）在审查时已死亡（SMR 1.96，95%可信区间1.44 - 2.62）。在简化的Cox比例风险模型中，以下因素与全因死亡风险增加独立相关：年龄较大（70 - 80岁：风险比9.96，95%可信区间3.30 - 30.03；80 - 91岁：风险比9.39，95%可信区间2.68 - 32.89）、毛利族或太平洋族裔（风险比2.48，95%可信区间1.17 - 5.29）、使用襻利尿剂（风险比3.99，95%可信区间2.15 - 7.40）、血清肌酐（每变化10 μmol/l；风险比1.04，95%可信区间1.00 - 1.07）以及存在皮下痛风石（风险比2.85，95%可信区间1.49 - 5.44）。皮下痛风石的存在是唯一与心血管（CV）死亡原因（风险比3.13，95%可信区间1.38 - 7.10）和非CV死亡原因（风险比3.48，95%可信区间1.25 - 9.63）均独立相关的基线变量。
痛风病程<10年的患者死亡风险增加。基线时皮下痛风石的存在是CV和非CV原因死亡率的独立预测因素。
