Analysis of risk factors of fever in hospitalized patients with acute gout

Abstract:

Objective To investigate the risk factors of fever in hospitalized patients with acute gout.Methods The data of 185 hospitalized patients with acute gout meeting the inclusion criteria were retrospectively analyzed and divided into moderate and high fever group（n=25），low fever group（n=25） and no fever group（n=135） according to body temperature. The clinical data，inflammatory indicators and medication data were compared. Then the two groups were divided into knee pain group（n=69） and pain free group（n=116） according to the presence or absence of knee pain.The risk factors of hospitalized gout fever were analyzed by binary Logistic regression.Results The white blood cell count in 3 groups was（9.2±2.3 vs. 8.6±3.3 vs. 7.7±2.5，P=0.022），neutrophil percentage（77.7±4.0 vs. 70.5±10.6 vs. 67.7±12.1，P=0.001），pain VAS score［3（3.0，4.0） vs. 2（2.0，3.0） vs. 2（1.5，3.0），P=0.001］，c-reactive protein（102（49，137） vs. 36（22，83） vs. 15（5，53），P=0.001） and ESR levels50（41，66） vs. 28（16，45） vs. 27（14，46），P=0.001］ were statistically significant. The white blood cell count and neutrophil percentage in the high fever group were higher than those in the no-fever group（P=0.012，P=0.001）. The pain VAS score，CRP and ESR in moderate and high fever group were higher than those in no fever group and low fever group（P=0.001，P=0.001，P=0.001 and P=0.014，P=0.033，P=0.011）.The proportion of NSAIDS used in low-fever group was higher than that in no-fever group（92% vs. 68.1%，P=0.015） and medium-high fever group（92% vs. 60.0%，P=0.008）. In the three groups，knee pain（56.0% vs 48.0% vs. 31.9%，P=0.036），first toe joint pain（6.0% vs. 0.0% vs. 25.9%，P=0.007），upper limb joint pain（40.0% vs. 16.0% vs. 17.8%，P=0.034） and multiple joint involvement（56.0% vs. 24.0% vs. 25.9%，P=0.008） were statistically significant. Proportion of ESR［43（21，56） vs. 25（14，41），P=0.001］，CRP［45（11，115） vs. 17（5，49），P=0.001］ and local treatment of joint cavity in patients with knee pain［（58.0% vs. 6.9%），P=0.001］ were higher than those without knee joint involvement. Logistic regression analysis showed that leukocytes（OR=1.171，95%CI=1.037-1.323，P=0.011），neutrophil percentage（OR=1.053，95%CI=1.020-1.087，P=0.002），CRP（OR=1.015，95%CI=1.008~1.021，P=0.001），ESR（OR=1.023，95%CI=1.008-1.039，P=0.003），pain VAS score（OR=1.674，95%CI=1.228-2.282，P=0.001），knee pain（2.428，95%CI=1.252-4.709，P=0.009） was a risk factor for hospitalized gout fever. First toe joint pain（OR=0.233，95%CI=0.068-0.804，P=0.021） was a protective factor for hospitalized gout fever. The increase of CRP level（OR=1.011，95%CI=1.005-1.018，P=0.001） and pain VAS score（OR=1.446，95%CI=1.035-2.019，P=0.031） were independent risk factors for hospitalized gout fever.Conclusion The proportion of hospitalized acute gout patients with fever was 27%（50/185），and patients with fever had higher inflammation levels and pain scores，a higher proportion of knee pain and multi-joint pain，and lower rates of first toe joint pain，which required stronger anti-inflammatory and analgesic therapy. In particular，high CRP level and high pain VAS score were independent risk factors for hospitalized gout fever.