Chang Jiang,1,2 Maichao Li,1,2 Ying Chen,3 Yuwei He,1,2 Xinde Li,1,2 Lingling Cui,1,2 Han Qi,1,2 Zan Cheng,1,2 Xiaoqing Zhang,3 Changgui Li,1– 3 Jie Lu1– 3 

1Shandong Provincial Clinical Research Center for Immune Diseases and Gout, Qingdao, People’s Republic of China; 2Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 3Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China

Correspondence: Jie Lu, Shandong Provincial Clinical Research Center for Immune Diseases and Gout, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, People’s Republic of China, 266003, Email 13127006046@163.com

Purpose: Previous studies have linked high-density lipoprotein cholesterol (HDL-C) to gout, but little is known about the dose-effect relationship between serum HDL-C levels and gout flares. This study aimed to quantify the association between the two during urate-lowering therapy initiation and develop a regression equation to predict gout flares.
Patients and Methods: We conducted a prospective, observational, single-center cohort study of men with gout. Patients were identified and grouped according to the level of serum HDL-C (1.16 mmol/L) at baseline and followed-up every four weeks until 12 weeks.
Results: A total of 394 participants completed the study (203 in the low HDL-C group; 191 in the high HDL-C group). The proportion of participants with gout flares in the low HDL-C group was significantly higher than in the high HDL-C group after 12 weeks follow-up (52.2% versus 35.6%, P=0.001). Patients with lower serum HDL-C level had higher risk of gout flares analyzed by restricted cubic spline and when serum HDL-C level = 1.15mmol/L, flareHR = 1. When combined with well-known risk factors, serum HDL-C predicted gout flares with an area under curve (AUC) of 0.75 (95% CI=0.70– 0.80). Based on the logistic regression coefficients, we derived the following regression equation: Logit (P)= − 2.282+0.05× [disease duration]+1.015× [recurrent flares in the last year]+0.698× [palpable tophus]+0.345× [serum urate]-1.349×[serum HDL-C].
Conclusion: Patients with gout presented a negative linear relationship between serum HDL-C and gout flares. Together with common clinical indicators, the AUC for gout flare prediction increased to 0.75. For patients with gout, remaining serum HDL-C level above 1.15 mmol/L may reduce the risk of gout flares.

Keywords: inflammation, prediction, AUC, life style intervention