Clustering Patients With Gout Based on Comorbidities and Biomarkers: A Cross-Sectional Study

Objective. This single-center clinical study identifies clusters of different phenotypes and pathophysiology subtypes of patients with gout and associated comorbidities.Methods. Patients clinically diagnosed with gout were enrolled between January 2018 and December 2019. Hierarchical cluster analyses were performed using clinical data or biological markers, inflammatory markers, and oxidative stress pathway metabolites assayed from serum and plasma samples. Subgroup clusters were compared using ANOVA for continuous data and chi-square tests for categorical data.Results. Hierarchical cluster analysis identified 3 clusters. Cluster 1 (C1; n = 24) comprised dyslipidemia, hypertension, and early-onset gout, without tophi. Cluster 2 (C2; n = 25) comprised hypertension, dyslip-idemia, nephrolithiasis, and obesity. Cluster 3 (C3; n = 39) comprised multiple comorbidities and tophi. Post hoc comparisons of data obtained from samples of patients in C1, C2, and C3 revealed significant dif-ferences in the levels of oxidative stress and inflammation-related markers, including 3-nitrotyrosine, tumor necrosis factor, C-reactive protein, interleukin (IL) 1 & beta;, IL-6, platelet-derived growth factor (PDGF)-AA, and PDGF-BB. Reclustering patients based on all markers as well as on the biological markers that signifi-cantly differed among the initial clusters identified similar clusters.Conclusion. Oxidative stress and inflammatory marker levels may affect the development and clinical man-ifestations (ie, clinical phenotypes) of gout. Measuring oxidative stress and levels of inflammatory cytokines is a potential adjunctive tool and biomarker for early identification and management of gout.

Automated summary

This study identifies different phenotypes and pathophysiology subtypes of patients with gout through cluster analysis. Levels of oxidative stress and inflammatory markers are found to be associated with the development and clinical manifestations of gout. These markers may serve as potential adjunctive tools and biomarkers for early identification and management of gout.