Background <p>Gout is a chronic disease caused by the deposition of sodium urate crystals, which is prone to multiple comorbidities, especially cardiovascular and kidney diseases. Patients with gout have higher all-cause and cause-specific mortality. However, it is unclear whether gout affects survival in ICU patients.</p> Methods <p>Data of the ICU patient cohort were obtained from the MIMIC IV database. The survival difference between the two groups was compared by Log-rank method. Cox regression was used to estimate the hazard ratio. Possible influencing factors were adjusted by matching. Quantitative variables were compared with Mann-Whitney/Wilcoxon test, and categorical variables were compared with Pearson’s Chi-squared test.</p> Results <p>The 30-day survival rate of gout patients in ICU was 87.13%, significantly higher than 84.88% in matched controls (<i>P</i> = 0.009), with hazard ratio (HR) of 0.83 (95% CI: 0.73–0.96). HR was reduced to 0.74 (95% CI: 0.64–0.84) after adjusting Charlson comorbidity Index (CCI) and 0.72 (95% CI: 0.63–0.82) after adjusting sequential organ failure assessment (SOFA). HR rose to 0.86 (95% CI: 0.75–0.98) after matching the first diagnosis, but the difference was still statistically significant (<i>P</i> = 0.029). After grouping matching for sepsis, HR decreased slightly, to 0.80.</p> Conclusion <p>Gout showed a protective effect on 30-day survival in ICU patients, indicating that the understanding of gout deserves further exploration.</p>