Skip to main content

Inpatient gout flare is multifactorial: comment on “clinical characteristics and risk factors for gout flare during the postsurgical period”

Dear the editor,

I have read with great interest a paper on the characteristics and risk factors of postsurgical gout flare in people with comorbid gout by Jeong and Jeon [1]. The paper postulated that pre-surgical serum urate ≥9 mg/dl and postsurgical change of serum urate were associated with higher risk of postsurgical gout flare, while the use of any gout medication or allopurinol was associated with lower risk of postsurgical gout flare. Although this hypothesis is intuitively sound, the statistical analysis used in the study may not be adequate to support such assertions.

Inpatient gout flare is a multifactorial event influenced by a combination of gout-related (e.g., serum urate level, tophus) and hospitalization-related factors (e.g., diuretic adjustment, acute kidney injury, surgery) [2]. Surgery may be associated with gout flare through more than one mechanisms, including volume status change, tissue hypoxia and systemic inflammatory response [3, 4]. The current study analyzed the association between various factors and the occurrence of postsurgical gout flare using a univariate logistic regression. The univariate model puts a single covariate against the outcome of interest (postsurgical flare) without adjusting for potential confounders. The model also does not consider possible association between some factors. For example, it could be argued that ‘allopurinol use’ may be related to lower ‘pre-surgical serum urate’ or men may have higher ‘pre-surgical serum urate’. These possible correlation cannot be adjusted for in a univariate analysis. Furthermore, the paper did not clarify the list of factors included in the univariate analysis. Consequently, it is difficult to be certain if all potential factors were accounted for in the analysis (e.g., gender, age, inflammatory markers, fluid intake, and kidney disease).

I therefore encourage the authors to clarify the full list of candidate factors included in the risk factor analysis and, if possible, perform additional multivariable logistic regression, incorporating all relevant factors into the model. The analysis may yield a different set of factors statistically and independently associated with the risk of postsurgical gout flare. Such knowledge would be a valuable addition to the existing literature regarding inpatient gout management and may help inform future research agenda on this particular subject.

Availability of data and materials

Not applicable.

References

  1. 1.

    Jeong H, Jeon CH. Clinical characteristics and risk factors for gout flare during the postsurgical period. Adv Rheumatol. 2019;59:31.

    Article  Google Scholar 

  2. 2.

    Jatuworapruk K, Grainger R, Dalbeth N, Taylor WJ. Development of a prediction model for inpatient gout flares in people with comorbid gout. Ann Rheum Dis. 2020;79:418–23.

    Article  Google Scholar 

  3. 3.

    Waldron JL, Ashby HL, Razavi C, et al. The effect of the systemic inflammatory response, as provoked by elective orthopaedic surgery, on serum uric acid in patients without gout: a prospective study. Rheumatology (Oxford). 2013;52:676–8.

    CAS  Article  Google Scholar 

  4. 4.

    Kang EH, Lee EY, Lee YJ, Song YW, Lee EB. Clinical features and risk factors of postsurgical gout. Ann Rheum Dis. 2008;67:1271–5.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Affiliations

Authors

Contributions

KJ is the sole author of the manuscript. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Kanon Jatuworapruk.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

KJ declares no competing interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jatuworapruk, K. Inpatient gout flare is multifactorial: comment on “clinical characteristics and risk factors for gout flare during the postsurgical period”. Adv Rheumatol 60, 44 (2020). https://doi.org/10.1186/s42358-020-00147-3

Download citation