Department of Rheumatology, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Rheumatology, VieCuri Medical Centre, Venlo, Tegelseweg 210, 5912, BL, Venlo, The Netherlands.
Clin Rheumatol. 2019 May;38(5):1385-1391. doi: 10.1007/s10067-019-04520-6. Epub 2019 Mar 30.
To investigate the cause-specific mortality and the possible involved clinical characteristics with increased mortality in a cohort of 700 patients with crystal-proven gout. The cause-specific mortality of gout was compared to the mortality of the general population.
Patients with arthritis referred for diagnosis were consecutively included in the Gout Arnhem-Liemers Cohort (GOAL). Joint fluid analysis was performed in all patients and only crystal-proven gout patients were included in this study. At inclusion clinical characteristics and laboratory values were collected. At follow-up patients who died were identified. Standardized mortality ratios (SMRs) were calculated for all-causes, cardiovascular diseases, cancer, and infectious diseases using indirect standardization methods for mortality outcomes and compared with the general population. The clinical characteristics of the patients who died were compared with those of the survivors and were analyzed by a logistic regression analysis to identify any associations with mortality.
The study population at inclusion contained 573 (81.9%) men and 127 (18.1%) females with an average age of 62.0 (SD 13.4). During 3500 person-years from inclusion visit till 31 May 2016, in 700 gout patients, 66 deaths (27 cardiovascular deaths, 15 cancer-related deaths, 8 infectious deaths, 16 various other causes) occurred in this cohort. The all-cause standardized mortality ratio in gout patients was 2.21 (95% CI 1.68-2.74). In this cohort, gout patients had a higher SMR for death attributed to cardiovascular diseases (6.75; 95% CI 4.64-8.86), infectious diseases (4.66; 95% CI 1.51-7.82) and cancer (3.58; 95% CI 1.77-5.39). Corrected for confounders high serum uric acid levels (SUA; > 0,56 mmol/L), tophaceous gout, a history of peripheral vascular disease, myocardial infarction, and heart failure at the inclusion visit were associated with increased mortality during follow-up.
Compared to the general population, gout patients have an increased association with all-cause disease mortality, especially attributed to cardiovascular diseases, cancer, and infectious diseases. This association is strongest in hyperuricemic (uric acid levels > 0,56 mmol/l) and tophaceous patients and in those with a history of peripheral vascular disease, myocardial infarction, and heart failure. Preventive measures like treatment of high SUA levels and treatment of cardiovascular risk factors need to be considered and evaluated.
研究在 700 例晶体证实的痛风患者队列中，特定病因死亡率的变化，并探讨可能与死亡率升高相关的临床特征。将痛风的病因特异性死亡率与普通人群的死亡率进行比较。
连续纳入关节炎患者进行诊断，并将他们纳入痛风 Arnhem-Liemers 队列（GOAL）研究。对所有患者进行关节液分析，仅纳入晶体证实的痛风患者。在纳入时收集临床特征和实验室值。在随访期间，确定死亡患者。使用间接标准化方法计算全因、心血管疾病、癌症和传染病的标准化死亡率比值（SMR），并与普通人群进行比较。比较死亡患者与存活患者的临床特征，并通过逻辑回归分析识别与死亡率相关的任何关联。
在纳入时，该研究人群包含 573 名（81.9%）男性和 127 名（18.1%）女性，平均年龄为 62.0（SD 13.4）岁。从纳入就诊到 2016 年 5 月 31 日的 3500 人年随访期间，在 700 例痛风患者中，该队列发生 66 例死亡（27 例心血管死亡，15 例癌症相关死亡，8 例感染性死亡，16 例其他各种原因死亡）。痛风患者的全因标准化死亡率为 2.21（95%CI 1.68-2.74）。在该队列中，痛风患者心血管疾病（6.75；95%CI 4.64-8.86）、传染病（4.66；95%CI 1.51-7.82）和癌症（3.58；95%CI 1.77-5.39）相关死亡率较高。在校正混杂因素后，高血清尿酸水平（SUA；>0.56mmol/L）、痛风石、外周血管疾病史、心肌梗死和心力衰竭在纳入时与随访期间的死亡率增加相关。
与普通人群相比，痛风患者全因疾病死亡率增加，尤其是与心血管疾病、癌症和传染病相关。这种关联在高尿酸血症（尿酸水平>0.56mmol/L）和痛风石患者以及有外周血管疾病史、心肌梗死和心力衰竭患者中最强。需要考虑并评估降尿酸水平和治疗心血管危险因素等预防措施。
