Is gout a risk factor for COVID-19?

A team of international scientists has recently determined the association between gout and risk of coronavirus disease 2019 (COVID-19) related death in a large cohort of patients. Their findings reveal that gout can significantly increase the risk of COVID-19 and related mortality, with women having a higher risk than men. The study is currently available on the medRxiv* preprint server.

Background

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.

Similarly, a higher risk of developing severe COVID-19 has been observed among patients with inflammatory diseases and those taking immunosuppressive medicines.

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.

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. 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 the current study, the scientists have 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.

Study design

The scientists 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.

Overall, they prepared four datasets to conduct the analysis:

To examine the association between gout and COVID-19 diagnosis, they analyzed 16,898 COVID-19 patients and 442,939 controls.

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.

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).

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).

Important observations

The analysis 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.

A 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.

Association between gout and COVID-19 diagnosis

The study identified a strong association between gout and COVID-19 diagnosis, with women having the risk of COVID-19 than men.

Association between gout and COVID-19 mortality

The study 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). This observation suggests that the presence of metabolic comorbidities does not additionally increase the risk of COVID-19 related death in women.  

Regarding gout-related medicines, no significant impact of colchicine and urate-lowering therapy was observed on the risk of COVID-19 related death.

Study significance

The study indicates 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.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Sanchari Sinha Dutta

Written by

Dr. Sanchari Sinha Dutta

Dr. Sanchari Sinha Dutta is a science communicator who believes in spreading the power of science in every corner of the world. She has a Bachelor of Science (B.Sc.) degree and a Master's of Science (M.Sc.) in biology and human physiology. Following her Master's degree, Sanchari went on to study a Ph.D. in human physiology. She has authored more than 10 original research articles, all of which have been published in world renowned international journals.

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