Outcomes of gout in patients with cirrhosis:A national inpatient sample-based study

BACKGROUND Hyperuricemia is a prerequisite for the development of gout.Elevated serum uric acid(UA)levels result from either overproduction or decreased excretion.A positive correlation between serum UA levels,cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established,but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes.We hypothesize that patients with cirrhosis will have poorer gout outcomes.AIM To explore the link between cirrhosis and the incidence of gout-related complications.METHODS This was a cross-sectional study.The national inpatient sample was used to identify patients hospitalized with gout,stratified based on a history of cirrhosis,from 2001 to 2013 via the International Classification of Diseases,Ninth Revision,Clinical Modification codes.Primary outcomes were mortality,gout complications and joint interventions.Theχ^(2)test and independent t-test were performed to assess categorical and continuous data,respectively.Multiple logistic regression was used to control for confounding variables.RESULTS Patients without cirrhosis were older(70.37±13.53 years vs 66.21±12.325 years;P<0.05).Most patients were male(74.63%in the cirrhosis group vs 66.83%;adjusted P<0.05).Patients with cirrhosis had greater rates of mortality(5.49%vs 2.03%;adjusted P<0.05),gout flare(2.89%vs 2.77%;adjusted P<0.05)and tophi(0.97%vs 0.75%;adjusted P=0.677).Patients without cirrhosis had higher rates of arthrocentesis(2.45%vs 2.21%;adjusted P<0.05)and joint injections(0.72%vs 0.52%;adjusted P<0.05).CONCLUSION Gout complications were more common in cirrhosis.Those without cirrhosis had higher rates of interventions,possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.

Superior Performance of Teaching and Transplant Hospitals in the Management of Hepatic Encephalopathy from 2007 to 2014

Background and Aims:Hepatic encephalopathy is a liver disease complication with significant mortality and costs.The aim of this study was to evaluate the relative performance of facilities based on their teaching status and transplant capability by correlating their connections to mortality,cost,and length of stay from 2007 to 2014.Methods:The Nationwide Inpatient Sample database was utilized to collect information on(USA)American patients admitted with a primary diagnosis of hepatic encephalopathy from 2007-2014.Hospitals were placed into one of four categories using their teaching and transplant status.Using regression analysis,mortality,length of stay and cost adjusted rate ratios were calculated.Results:The study revealed that teaching transplant centers had a mortality risk ratio of 0.783(95%confidence interval(CI):0.750-0.819,p<0.001).Blacks had the highest mortality risk ratio,of 1.273(95%CI:1.217-1.331,p<0.001).Furthermore,teaching transplant hospitals had a cost rate ratio of 1.226(95%CI:1.214-1.238,p<0.001)and a length of stay rate ratio of 1.104(95%CI:1.093-1.115,p<0.001).Conclusions:It appears that admission to transplant facilities for hepatic encephalopathy is associated with reduced mortality but increased costs and longer stay independent of transplantation.Moreover,factors impacting black mortality should also be examined more closely.