The GOUT-36 rule, a gout flare risk stratifica- tion tool for patients with gout hospitalized for non-gout conditions, is simple and sensitive for classifying people with high risk for inpatient gout flare, according to a study published in Rheumatology (Oxford). The prediction rule for inpatient gout flare was derived from a cohort of 625 hospitalized people with comorbid gout. The rule had four items: 1) no pre-admission flare prophylaxis, 2) no pre-admission urate-low- ering therapy, 3) tophus, and 4) pre-admission serum urate greater than 0.36 mmol/l within the previous year. The study team validated the GOUT-36 rule in a prospective cohort of 284 hospitalized people with comorbid gout. They found that the GOUT-36 rule had a sensitivi- ty of 75%, specificity of 67%, and area under the curve of 0.71 for classifying people at high risk for developing inpatient gout flare. Four risk groups were developed: low (no items), moder- ate (one item), high (two items), and very high risk (three or four items). In a population with frequent (overall 34%) in-hospital gout flare, 80% of patients with very high risk developed flare, while 11% of low-risk people had inpatient flare. The study authors said the rule may help inform clinical decision and future research on the prevention of inpatient gout flare.
