title: Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly.
abstract: BACKGROUND
  Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards.
  
  
  METHODS
  While the prevalence of gout was calculated by counting patients with this diagnosis hyperuricemia was inferred in patients taking allopurinol at hospital admission or discharge, on the assumption that this drug was only prescribed owing to the finding of high serum levels of uric acid. A series of clinical and demographic variables were evaluated for their association with gout/hyperuricemia.
  
  
  RESULTS
  Of 1380 patients, 139 (10%) had a diagnosis of gout or were prescribed allopurinol. They had more co-morbidities (7.0 vs 5.6; P<0.0001) and consumed more drugs (6.8 vs 5.0; P<0.0001). The CIRS (co-morbidity index) was worse in these patients (OR 1.28 95% CI 1.15-1.41). Multivariable regression analysis showed that only renal and heart failures were independently associated with gout/allopurinol intake. Moreover, this combined event was associated with an increased risk of adverse events during hospitalization (OR 1.66, 95% CI 1.16-2.36), but not with the risk of re-hospitalization, length of hospital stay or death.
  
  
  CONCLUSIONS
  Gout/allopurinol intake has a high prevalence in elderly patients acutely admitted to hospital and are associated with renal and cardiovascular diseases, an increased rate of adverse events and a high degree of drug consumption. In contrast, this finding did not affect the length of hospitalization nor hospital mortality.
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address: carlotta.franchi@marionegri.it.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.affiliation: Internal Medicine I, Policlinico IRCCS San Donato, University of Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.affiliation: Internal Medicine I, Policlinico IRCCS San Donato, University of Milan, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Conca
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Codjo D
authors.initials: CD
authors.lastname: Djade
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.affiliation: Department of Clinical and Experimental Science, University of Brescia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Department of Internal Medicine, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.affiliation: Scientific Direction, IRCCS Maggiore Hospital Foundation, Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006073:Gout / Q000188:drug therapy / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033461:Hyperuricemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid; D000493:Allopurinol
keywords: Allopurinol; Comorbidities; Elderly; Gout; Hyperuricemia; Outcomes