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February 6, 2026Therapeutic Advances in Musculoskeletal Disease0 citationsOpen Access

Association between immune-inflammation index and the risk of gout attack: a systematic review and meta-analysis

ZGZhiwei GuanChengdu University of Traditional Chinese Medicine MZMinjun ZhangChengdu University of Traditional Chinese Medicine YYYe YuanChengdu University of Traditional Chinese Medicine

Key Points

This study aims to explore the relationship between immune-inflammation indices and acute gout attacks.
Conducted a systematic review and meta-analysis using databases like PubMed and Embase.
Screened literature and extracted data independently by two investigators.
Utilized standardized mean difference and 95% confidence interval to evaluate inflammatory index differences.
Applied a random-effects model for analyzing predictive value of inflammatory indices.
Conducted sensitivity and subgroup analyses to assess heterogeneity.
Included 8 articles with 2655 participants in the meta-analysis.
Neutrophil-to-lymphocyte ratio (NLR) showed significant predictive value (SMD: 0.75; 95% CI: 0.48–1.03).
Platelet-lymphocyte ratio (PLR) also demonstrated significant predictive value (SMD: 0.52; 95% CI: 0.24–0.79).
NLR and PLR were stable predictors for acute gout across subgroups, but PLR showed potential sources of heterogeneity.

Abstract

Background: Evidence shows that gout attack is closely related to immune and inflammatory levels. However, there are limited evidence-based results for immune-inflammatory indices to predict gout attacks. Objectives: This study aimed to explore the predictive value of immune-inflammation index for acute gout. Design: Systematic review and meta-analysis. Data sources and methods: A systematic search was conducted based on PubMed, Web of Science, Embase, Cochrane, CNKI , and Wanfang . Literature screening and data extraction were performed independently by two investigators, and standardized mean difference (SMD) and 95% confidence interval (95% CI) were used to evaluate the differences in inflammatory indexes between gout patients and individuals in the healthy control group. A random-effects model was used to analyze the predictive value of different inflammatory indexes for acute gout patients. In addition, sensitivity analysis and subgroup analysis were also conducted to explore the sources of heterogeneity. Results: A total of 8 articles involving 2655 participants were included in this meta-analysis. The findings showed that both neutrophil-to-lymphocyte ratio (NLR; SMD: 0.75; 95% CI: 0.48–1.03) and platelet-lymphocyte ratio (PLR; SMD: 0.52; 95% CI: 0.24–0.79) showed significant value in predicting acute gout attacks. The sensitivity analysis results showed that both NLR and PLR were significantly stable in predicting acute gout attacks. Meanwhile, subgroup analyses were performed based on region, sample size, and age. The results showed that the predictive value of NLR and PLR for acute gout was significant in all subgroups, and age and sample size were potential sources of heterogeneity in PLR. However, no sources of heterogeneity were found in NLR. Conclusion: NLR and PLR are well-performed in predicting acute gout attacks. Given a lack of prospective studies, a limited number of related references, and significant heterogeneity, large-scale prospective studies are needed to verify the relationship between immune-inflammation index and gout attacks.

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