Outcomes in Patients With Tumor Lysis Syndrome and Comorbid Gout: A Propensity-Matched Study From a Global Federated Health Research Network

Introduction Tumor lysis syndrome (TLS) is an oncologic emergency that can result in cardiac arrhythmias, acute kidney injury (AKI), seizures, and death. Uric acid released in TLS can be managed with gout medications. We used a national database to study the impact of gout on patients with TLS. Methods The TriNetX US Collaborative Network was used for ICD-10 (International Classification of Diseases) code data. Adults with TLS were divided according to gout diagnosis. Uric acid-lowering therapies (ULTs), including allopurinol, febuxostat, and rasburicase, were studied. Cohorts were propensity-matched based on age, sex, race, and comorbidities. Rates of mortality, AKI, seizures, atrial fibrillation (AF), atrial flutter (AFL), Torsade de Pointes (TP), continuous renal replacement therapy (CRRT), septic arthritis, sepsis, intensive care unit (ICU) admission, and hospital admission were tracked for five years. Results TLS without gout demonstrated a higher risk of mortality (HR: 1.146; 95% CI: 1.065-1.233; p = 0.0038), AKI (HR: 1.02; 95% CI: 0.956-1.089; p = 0.0017), and sepsis (HR: 1.014; 95% CI: 0.926-1.111; p = 0.0158). TLS without allopurinol had higher risks of AKI (HR: 1.489; 95% CI: 1.337-1.658; p = 0.000), AF/AFL (HR: 1.046; 95% CI: 0.886-1.235; p = 0.002), and sepsis (HR: 1.375; 95% CI: 1.188-1.591; p = 0.027). TLS without rasburicase had a higher risk of mortality (HR: 1.165; 95% CI: 0.747-1.818; p = 0.024). Conclusion Patients with TLS have a higher risk of mortality, AKI, and sepsis than patients with TLS and gout. Gout and ULTs could be protective in TLS. Further research is warranted.