VAMC, Birmingham, Alabama and University of Alabama at Birmingham.
University of Alabama at Birmingham.
Arthritis Care Res (Hoboken). 2021 Jun;73(6):898-908. doi: 10.1002/acr.24201.
To study the epidemiology of serious infections in patients hospitalized with gout.
We identified patients with gout hospitalized with a primary diagnosis of pneumonia, sepsis/bacteremia, urinary tract infection (UTI), skin and soft tissue infections (SSTIs), or opportunistic infections (OIs) in a US National Inpatient Sample from 1998 to 2016 and examined factors associated with utilization and mortality.
We noted 1,140,085 hospitalizations of patients with serious infections and gout (11% of all hospitalizations of patients with gout; 1998-2000 [8.9%], 2015-2016 [14.5%]). Compared to patients without gout, patients with gout hospitalized with serious infections were older (median age 65 versus 74 years), more of them had a Charlson-Deyo comorbidity index score ≥2 (42% versus 65%), and fewer were female (53% versus 35%) or non-White (40% versus 35%), respectively. The most common infection was pneumonia (52%) in 1998-2000 and sepsis (52%) in 2015-2016. Median hospital charges and hospital stays were higher for patients with sepsis and OIs in 2015-2016 ($41,000-$42,000; 5.1-5.5 days) versus those with UTI, pneumonia, or SSTIs ($15,000-$17,000; 3.0-3.9 days). Compared to patients with sepsis, the multivariable-adjusted odds of health care utilization and in-hospital mortality were significantly lower for patients with UTI, SSTIs, and pneumonia, and non-home discharge or in-hospital mortality were lower in patients with OIs. Among patients hospitalized with infections, older age, Medicaid coverage, a higher Charlson-Deyo comorbidity index score, Black race, and Northeast and nonrural hospital location were associated with significantly higher health care utilization and mortality, while female sex, Medicare insurance, and lower income were associated with higher utilization.
Given an increasing rate of serious infections, especially sepsis and pneumonia, in individuals with gout, development of effective interventions targeting factors associated with health care utilization and mortality will improve outcomes and reduce burden.
研究住院痛风患者严重感染的流行病学。
我们在美国国家住院患者样本中确定了 1998 年至 2016 年因肺炎、脓毒症/菌血症、尿路感染 (UTI)、皮肤和软组织感染 (SSTI) 或机会性感染 (OI) 住院的原发性诊断为痛风的患者，并研究了与利用和死亡率相关的因素。
我们注意到有 1140085 例患有严重感染和痛风的患者住院治疗（所有痛风患者住院治疗的 11%；1998-2000 年[8.9%]，2015-2016 年[14.5%]）。与没有痛风的患者相比，患有严重感染的痛风患者年龄更大（中位年龄 65 岁 vs 74 岁），Charlson-Deyo 合并症指数评分≥2 的患者比例更高（42% vs 65%），女性（53% vs 35%）或非白人（40% vs 35%）的比例较低。最常见的感染是 1998-2000 年的肺炎（52%）和 2015-2016 年的脓毒症（52%）。2015-2016 年，脓毒症和 OI 患者的中位住院费用和住院时间高于 UTI、肺炎和 SSTI 患者（41000-42000 美元；5.1-5.5 天）。与脓毒症患者相比，UTI、SSTIs 和肺炎患者的医疗保健利用和院内死亡率的多变量调整比值明显较低，而 OI 患者的非家庭出院或院内死亡率较低。在患有感染的患者中，年龄较大、医疗补助覆盖、较高的 Charlson-Deyo 合并症指数评分、黑人种族以及东北部和非农村医院位置与更高的医疗保健利用和死亡率显著相关，而女性、医疗保险和较低的收入与更高的利用率相关。
鉴于痛风患者严重感染（尤其是脓毒症和肺炎）的发生率不断增加，制定针对与医疗保健利用和死亡率相关因素的有效干预措施将改善结局并减轻负担。
