Study Finds That Gout Is A Risk Factor For SARS-CoV-2 infections And COVID-19 Mortality. Women With Gout Have Higher COVID-19 Death Risk Than Men!
Gout and COVID-19:
Researchers from the University of Otago-New Zealand, University of Alabama at Birmingham-USA, University of Queensland-Australia and the University of Auckland-New Zealand have in a new study found that gout is a risk factor for SARS-CoV-2 infections and COVID-19 mortality. The study findings also showed that women with gout have higher COVID-19 death risk than men!
The international study team used data from the UK Biobank that included 15,560 people with gout. Multivariable-adjusted logistic regression was employed in the following analyses using a case-control study design: Analysis A, to test for association between gout and COVID-19 diagnosis (n=459,837); Analysis B, to test for association between gout and death related to COVID-19 in a case-control cohort of individuals who died or survived with COVID-19 (n=16,336); Analysis C, to test for association between gout and death related to COVID-19 in the entire UK Biobank cohort (n=459,837); Analysis D, to stratify by prescription of urate-lowering therapy (ULT) and colchicine on the risk of death related to COVID-19 in a subset of the UK Biobank cohort with medication data (n=341,398).
The study findings showed that gout was associated with diagnosis of COVID-19 in analysis A (OR=1.2 [1.1 ; 1.3]) but not with risk of death in the COVID-19-diagnosed group in analysis B. In analysis C gout associated with risk of death related to COVID-19 in the unadjusted model (OR=3.9 [3.3 ; 4.7]), in Model 1 adjusted for demographic factors (OR=1.8 [1.5 ; 2.1]) and in the fully adjusted Model 2 (OR=1.3 [1.1 ; 1.6]). In Analysis C risk was higher in women than men in Model 1 adjusted for demographic factors (OR=3.5 [2.4 ; 5.0] and OR=1.5 [1.2 ; 1.8], respectively) with the difference maintained after additional adjustment for eight metabolic co-morbidities (ORMen
=1.2 [0.9 ; 1.5], ORWomen
=1.9 [1.3 ; 2.9]). There were no statistically significant differences in risk of death related to COVID-19 according to prescription of ULT or colchicine.
The study findings concluded that g
out is a risk factor for death related to COVID-19 using the UK Biobank cohort with an increased risk in women with gout that was also driven by risk factors outside metabolic co-morbidities of gout.
The study findings were published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2021.09.28.21264270v1
To date, severe COVID-19 is associated with aberrant activation of the innate immune system and excessive generation of proinflammatory mediators. In this context, studies have highlighted that patients with inflammatory diseases, including rheumatic arthritis, may have a higher risk of COVID-19 diagnosis.
At the same time, a higher risk of developing severe COVID-19 has been observed among patients with inflammatory diseases and those taking immunosuppressive medicines.
Also, according to the COVID-19 Global Rheumatology Alliance report, hypertension due to cardiovascular disease and chronic lung disease can significantly increase the risk of COVID-19-related mortality among rheumatic disease patients. https://ard.bmj.com/content/80/7/930
The medical condition gout is a type of inflammatory arthritis
, observed in 2.5% of the UK population, 3.9% of the US population, and 14% of individuals belonging to Pacific ethnicity.
Importantly the absolute risk of poor COVID-19 outcomes is expected to be higher among gout patients as the disease is associated with many COVID-19 related risk factors, including cardiovascular disease, diabetes, diabetic neuropathy, and obesity.
In this research, the Gout-COVID-19
study team estimated the risk of COVID-19 diagnosis and mortality in a large number of gout patients. Moreover, they have assessed whether gout-related medicines can influence the risk of COVID-19 mortality.
The study team collected COVID-19 and gout-related data from the UK Biobank Resource. They identified a total of 16,898 COVID-19 patients (survived or dead) and 15,560 gout patients in the resource.
The team prepared four datasets to conduct the analysis with the following four main objectives:
-1) To examine the association between gout and COVID-19 diagnosis, they analyzed 16,898 COVID-19 patients and 442,939 controls.
-2) To examine the association between gout and COVID-19-related mortality in COVID-19 patients, they involved 1,111 COVID-19 patients who died and 15,225 COVID-19 patients who survived.
-3) To examine the association between gout and COVID-19 mortality at the population level, they involved 1,111 COVID-19 patients who died and 458,726 controls (including 15,787 COVID-19 patients who survived).
-4) To examine the association of urate-lowering therapy and colchicine with COVID-19 mortality, they involved 690 COVID-19 patients who died and 340,708 controls (including 12,849 COVID-19 patients who survived).
The study findings revealed that the frequency of gout patients who died of COVID-19 is 0.86% compared to 0.24% in the entire study population. In addition, women with gout exhibited a higher risk of death than men.
Also a much higher frequency of metabolic disorders as gout-related comorbidities was identified in COVID-19 patients who died. Women with gout showed a higher frequency of comorbidities than men.
Furthermore the research identified a strong association between gout and COVID-19 diagnosis, with women having the risk of COVID-19 than men.
Also the study findings indicated that gout patients have a significantly higher risk of COVID-19-related mortality. Furthermore, the risk was substantially higher in women with gout than men. Notably, the risk remained the same for women when the analysis was done after adjusting for eight metabolic comorbidities (hypertension, dyslipidemia, diabetes, chronic kidney disease, obesity, coronary heart disease, cerebrovascular disease, and heart failure).
Interestingly this observation suggests that the presence of metabolic comorbidities does not additionally increase the risk of COVID-19 related death in women.
Pertaining to gout-related medicines, no significant impact of colchicine and urate-lowering therapy was observed on the risk of COVID-19 related death.
On the whole, the study findings indicate that gout patients are at higher risk of COVID-19 related death and that the risk is higher among female patients than male patients. Moreover, the study identifies eight gout-related metabolic comorbidities that can increase the risk of death in male gout patients. However, these comorbidities might not additionally impact the mortality risk in female patients, despite their higher susceptibility to gout-related metabolic comorbidities.
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