Dual-energy computed tomography assessment of monosodium urate load predicts gout flare risk—a prospective observational cohort study
10.3760/cma.j.cn311282-20231229-00236
- VernacularTitle:双能量计算机断层扫描评估单钠尿酸盐负荷预测痛风发作风险——前瞻性、观察性队列研究
- Author:
Rui ZHOU
1
;
Xiaobo AI
;
Rongrong SUN
;
Zhen LIU
;
Xiaoou JIN
;
Feng ZHANG
;
Maichao LI
;
Xiaomei XUE
;
Changgui LI
;
Lin HAN
Author Information
1. 青岛大学附属医院痛风病实验室 266003
- Keywords:
Dual-energy computed tomography;
Monosodium urate crystal;
Gout;
Flare
- From:
Chinese Journal of Endocrinology and Metabolism
2024;40(7):573-579
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate whether dual-energy computed tomography(DECT) measurement of monosodium urate(MSU) crystal loading can predict the risk of gout flares.Methods:A single-center, prospective, observational study included 229 gout patients initially diagnosed at the Gout Clinic of Qingdao University from August 2021 to February 2022. The patients underwent MSU assessment of the bilateral feet using DECT. Following enrolment, all patients commenced uric acid-lowering therapy(ULT) and were followed up at 3 and 6 months. Patients who experienced at least one flare within 6 months were compared with those who did not, and the odds ratio( OR) for the risk of gout flares was calculated. Results:Patients who experienced gout flare had a significantly longer disease duration[(6.69±5.42) vs(4.14±4.86) years, P<0.01], a higher number of flares in the past year(4.80±1.73 vs 2.02±1. 23, P<0.01), a higher proportion of fatty livers(11.0% vs 1.4%, P<0.05), and a greater volume of MSU crystals in the feet[(3.52±9.74) vs(0.29±0.98)cm 3,P<0.05] compared to patients without gout flare. The results of the multifactorial logistic regression analysis indicated that the number of flares in the past year( OR=1.295, 95% CI 1.032-1.613, P<0.05) and feet MSU crystal volume( OR=3.245, 95% CI 1.164-9.064, P<0.05) were independent risk factors for gout flares. The receiver operating characteristic(ROC) curve indicated the integration of the MSU prediction model into the clinical prediction model resulted in a comprehensive prediction model with an area under curve(AUC) value of 0.780(95% CI 0.710-0.840), sensitivity of 0.83, and specificity of 0.62. Internal validation of the comprehensive prediction model using the Bootstrap method yielded a C-index of 0.770(95% CI 0.701-0.833) for predicting flares. The calibration curve of the model demonstrated a good fit between the predicted probability of flares and the actual probability, indicating high calibration accuracy. Conclusion:The volume of MSU crystals in the feet is an independent risk factor for flares following ULT. A larger volume of MSU crystals in the foot increases the likelihood of a flare. This study provides a basis for early prediction of flare and a reference for early preventive treatment.
