Jeong Stephanie, Tan Irene J
Internal Medicine, Temple University Hospital, Philadelphia, USA.
Rheumatology, Einstein Medical Center, Philadelphia, USA.
Cureus. 2020 Jun 13;12(6):e8605. doi: 10.7759/cureus.8605.
Background Heart failure is a clinical syndrome with significant morbidity, mortality, and financial burden. These factors are magnified in patients with associated comorbidities. Therefore, addressing such conditions is critical in decreasing healthcare costs and improving patient outcomes. Gout is a major comorbidity in patients with heart failure. Acute gout flares that occur in the context of acute heart failure exacerbations (AHFE) form an independent risk factor for increased readmissions or death. In this study, we characterized the frequency and outcomes of acute gout flares in patients treated with intravenous (IV) bumetanide for AHFE. Methods This single-center retrospective cohort study included 130 adult patients admitted in a tertiary-care hospital between August 2016 and June 2018. Chart review identified patients who were hospitalized for AHFE with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code I50, received IV bumetanide, and developed an acute gout flare. Data were analyzed using the chi-square test for categorical variables and the two-sample t-test for continuous variables. Results The annualized frequency of acute gout while receiving IV bumetanide for AHFE was 7.17%. Chronic gout patients who were on colchicine and/or allopurinol while hospitalized were less likely to develop acute gout while receiving IV bumetanide for AHFE compared with those taking neither medication (p-value =0.002). There was no significant difference in length of stay or 30-day readmissions between those who developed acute gout and those who did not. Conclusions Acute gout flares occur with a notable frequency in patients hospitalized for AHFE who are administered IV bumetanide. It is important to continue patients' outpatient gout regimens in an effort to mitigate acute gout flares during this time.
背景 心力衰竭是一种具有显著发病率、死亡率和经济负担的临床综合征。在伴有合并症的患者中，这些因素会进一步加剧。因此，应对此类情况对于降低医疗成本和改善患者预后至关重要。痛风是心力衰竭患者的主要合并症。在急性心力衰竭加重（AHFE）背景下发生的急性痛风发作是再入院或死亡增加的独立危险因素。在本研究中，我们对接受静脉注射布美他尼治疗AHFE的患者急性痛风发作的频率和结局进行了特征描述。
方法 这项单中心回顾性队列研究纳入了2016年8月至2018年6月在一家三级医院住院的130例成年患者。通过病历审查确定因AHFE住院且国际疾病分类第十版（ICD-10）诊断代码为I50、接受静脉注射布美他尼并发生急性痛风发作的患者。使用卡方检验分析分类变量数据，使用两样本t检验分析连续变量数据。
结果 在接受静脉注射布美他尼治疗AHFE期间，急性痛风的年化发作频率为7.17%。与未服用任何药物的患者相比，住院期间服用秋水仙碱和/或别嘌醇的慢性痛风患者在接受静脉注射布美他尼治疗AHFE时发生急性痛风的可能性较小（p值 = 0.002）。发生急性痛风的患者与未发生急性痛风的患者在住院时间或30天再入院率方面没有显著差异。
结论 在接受静脉注射布美他尼治疗的AHFE住院患者中，急性痛风发作频率显著。在此期间继续患者的门诊痛风治疗方案以减轻急性痛风发作很重要。
