title: Allopurinol use is associated with greater functional gains in older rehabilitation patients.
abstract: BACKGROUND
  the xanthine oxidase system produces reactive oxidative species and its inhibition by allopurinol has been shown to have beneficial effects on cardiovascular function. Oxidative stress has also been implicated in the development of sarcopenia. Allopurinol, a xanthine oxidase inhibitor, both reduces oxidative stress and acts as a potential oxygen-sparing agent. We examined the association between allopurinol use and functional outcomes after rehabilitation in a cohort of older people.
  
  
  METHODS
  analysis of routinely collected clinical data from a single rehabilitation unit. Data were prospectively collected on all admissions to the Dundee Medicine for the Elderly rehabilitation unit between 1 January 1999 and 31 December 2008. Multivariate analyses were performed to examine the difference between the 20-point Barthel score on admission and discharge, adjusting for age, sex, admission Barthel score, anti-platelet use and comorbid disease.
  
  
  RESULTS
  a total of 3,593 patients were included in the analysis and 3% of patients were taking allopurinol on discharge (n = 102). Improvement in Barthel scores was greater in the allopurinol group than the non-allopurinol group (4.7 versus 3.6 points, mean difference 1.1, 95% CI: 0.4-1.8, P = 0.002). When adjusted for age, sex, admission Barthel, presenting disease and number of drugs on discharge, improvement in the Barthel score was still greater in the allopurinol group (4.8 versus 3.8 points, mean difference 0.94, 95% CI: 0.3 to 1.6, P = 0.006).
  
  
  CONCLUSIONS
  this retrospective observational study suggests that allopurinol use is associated with a greater degree of improvement in function as measured by the Barthel score during rehabilitation in an older inpatient population. Prospective randomised controlled trials are required to further investigate this finding.
authors.affiliation: Department of Medicine for the Elderly, NHS Tayside, Ninewells Hospital Dundee, Dundee DD19SY, UK. louise.beveridge@nhs.net
authors.forename: Louise A
authors.initials: LA
authors.lastname: Beveridge
authors.forename: Lynn
authors.initials: L
authors.lastname: Ramage
authors.forename: Marion E T
authors.initials: ME
authors.lastname: McMurdo
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Miles D
authors.initials: MD
authors.lastname: Witham
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000188:drug therapy* / Q000201:enzymology / Q000503:physiopathology; D012606:Scotland; D013997:Time Factors; D016896:Treatment Outcome; D014969:Xanthine Oxidase / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D000975:Antioxidants; D004791:Enzyme Inhibitors; D000493:Allopurinol; D014969:Xanthine Oxidase