A novel risk stratification tool – the GOUT-36 – was found to be sensitive for the classification of patients with gout hospitalized for nongout conditions at increased risk for gout flare, according to study results published in Rheumatology.

Up to 35% of patients with gout hospitalized for nongout conditions may develop gout flare. Owing to the lack of clinical tools to predict the risk for inpatient gout flare, the objective of the current study was to assess the value of a simple prediction rule in classifying hospitalized patients at a high risk for gout flare.

A derivation cohort that included 625 hospitalized patients with gout from New Zealand was used to identify items for the prediction rule called GOUT-36, which was an acronym for no pre-admission GOut flare prophylaxis; no preadmission Urate-lowering therapy (allopurinol, febuxostat, probenecid, benzbromarone, or sulfinpyrazone), according to medical records; Tophus; and preadmission serum urate of more than 0.36 mmol/L in the previous year.

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Based on the GOUT-36 rule, 4 risk groups were developed: low risk (no item), moderate risk (1 item), high risk (2 items), and very high risk (3 or 4 items).

The risk stratification tool was then validated in a prospective cohort of 284 hospitalized patients with gout from Thailand and China. Of the 284 admissions in the validation cohort, 96 were flare episodes (34%).

In the validation vs derivation cohort, the GOUT-36 rule had lower sensitivity (75% vs 84%, respectively), but superior specificity (67% vs 50%, respectively). The GOUT-36 rule had a positive predictive value of 0.54 and a negative predictive value of 0.84.

The prevalence of inpatient gout flare by risk group was 11%, 18%, 43%, and 80% for those in the low, moderate, high, and very high risk groups, respectively.

The study had several limitations, including potential selection bias in terms of patients with gout flare who required a rheumatologist’s consult, data limited to inpatients and could not be extrapolated to primary care or outpatient settings, and the relatively small number of flare events that precluded assessment of the GOUT-36 rule in specific subgroups.

“The rule may help clinicians identify people with high risk for inpatient flare on the first day of hospital admission and help promote the concept that gout flare prevention is included in the overall plan for that particular hospital event,” the researchers concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Jatuworapruk K, Grainger R, Dalbeth N, et al. The GOUT-36 prediction rule for inpatient gout flare in people with comorbid gout: derivation and external validation. Rheumatology (Oxford). Published online July 23, 2021. doi:10.1093/rheumatology/keab590

This article originally appeared on Rheumatology Advisor