Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study

Jorge Sinclair De Frías; Shahin Isha; Lorenzo Olivero; Lekhya Raavi; Sai Abhishek Narra; Smit Paghdar; Sadhana Jonna; Parthkumar Satashia; Rachel Hannon; Jessica Blasavage; Layton White; Titilope Olanipekun; Pankaj Bansal; Sean Kiley; Juan Carlos Leoni; Jose Nativí; Melissa Lyle; Mathew Thomas; Basar Sareyyupoglu; Si Pham; Michael Smith; Pablo Moreno Franco; Parag Patel; Devang Sanghavi

doi:10.1186/s41927-024-00380-z

Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study

BMC Rheumatol. 2024 Feb 29;8(1):9. doi: 10.1186/s41927-024-00380-z.

Authors

Jorge Sinclair De Frías¹, Shahin Isha¹, Lorenzo Olivero¹, Lekhya Raavi¹, Sai Abhishek Narra¹, Smit Paghdar¹, Sadhana Jonna¹, Parthkumar Satashia¹, Rachel Hannon¹, Jessica Blasavage^{1

2}, Layton White¹, Titilope Olanipekun³, Pankaj Bansal⁴, Sean Kiley¹, Juan Carlos Leoni⁵, Jose Nativí⁵, Melissa Lyle⁵, Mathew Thomas⁶, Basar Sareyyupoglu⁶, Si Pham⁶, Michael Smith⁷, Pablo Moreno Franco¹, Parag Patel⁵, Devang Sanghavi⁸

Affiliations

¹ Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA.
² Associate Clinical Consultant, Abiomed, Jacksonville, FL, USA.
³ Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI, USA.
⁵ Division of Advanced Heart Failure and Transplantation, Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA.
⁶ Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.
⁷ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA.
⁸ Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road S, 32224, Jacksonville, FL, USA. Sanghavi.Devang@mayo.edu.

Abstract

Background: Impella is an advanced ventricular assist device frequently used as a bridge to heart transplantation. The association of Impella with increased rates of gout flares has not been studied. Our primary aim is to determine the rates of gout flares in patients on Impella support.

Methodology: A retrospective study was conducted between January 2017 and September 2022 involving all patients who underwent heart transplantation. The cohort was divided into two groups based on Impella support for statistical analysis. In patients receiving Impella support, outcome measures were compared based on the development of gout flares. 1:1 nearest neighbor propensity match, as well as inverse propensity of treatment weighted analyses, were performed to explore the causal relationship between impella use and gout flare in our study population.

Results: Our analysis included 213 patients, among which 42 (19.71%) patients were supported by Impella. Impella and non-Impella groups had similar age, race, and BMI, but more males were in the Impella group. Gout and chronic kidney disease were more prevalent in Impella-supported patients, while coronary artery disease was less common. The prevalence of gout flare was significantly higher in Impella patients (30.9% vs. 5.3%). 42 Impella-supported patients were matched with 42 patients from the non-impella group upon performing a 1:1 propensity matching. Impella-supported patients were noted to have a significantly higher risk of gout flare (30.9% vs. 7.1%, SMD = 0.636), despite no significant difference in pre-existing gout history and use of anti-gout medications. Impella use was associated with a significantly increased risk of gout flare in unadjusted (OR 8.07), propensity-matched (OR 5.83), and the inverse propensity of treatment-weighted analysis (OR 4.21).

Conclusion: Our study is the first to identify the potential association between Impella support and increased rates of gout flares in hospitalized patients. Future studies are required to confirm this association and further elucidate the biological pathways. It is imperative to consider introducing appropriate measures to prevent and promptly manage gout flares in Impella-supported patients.

Keywords: Cardiogenic shock; Circulatory failure; Gout; Hemolysis; Hemorrhage.