Get OUT: Factors Associated With a Longer Length of Stay in Patients Admitted With an Acute Gout Flare, and the Effects of Anakinra on Length of Stay

Objective

Acute gout flares (AGF) are a significant burden to healthcare systems globally, due to the prolonged length of stay (LOS). The study's aim was to audit patients admitted to our facility with AGF, then re-audit after the introduction of interleukin-1 receptor antagonist anakinra in select patients to assess whether it would result in a reduced LOS.

Methods

A single-center retrospective audit was conducted on 62 hospitalizations for AGF in 2019 that met inclusion criteria. Data on patient demographics, comorbidities, and clinical parameters (number of joints involved, C-reactive protein (CRP), urate levels, and tophi) were analyzed using multivariable Poisson regression models to determine predictors of LOS. We then compared patients that received anakinra in 2020 (n = 7) with a historical control group (n = 13).

Results

The average LOS in 2019 for AGF was 3.36 days (1.22–4.28). CRP, prior use of allopurinol, and impaired mobility levels were significant predictors of prolonged LOS, with respective coefficients of 0.0036 (95% CI: 0.0023–0.0050, p < 0.0001), 0.321 (95% CI: 0.043–0.599, p = 0.023), and 0.708 (95% CI: 0.416–1.000, p < 0.0001). When CRP was treated as a controlled variable, patients treated in 2020 with anakinra demonstrated a 0.493-day reduction in LOS compared to the control group, which was statistically significant (p = 0.043).

Conclusion

CRP levels, allopurinol use, and impaired mobility are key predictors of prolonged LOS in AGF. Although the use of anakinra shows promise in reducing LOS and costs, larger studies are needed to confirm its efficacy.