Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study Clinical article
Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study Clinical article
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DOI：
10.3171/2013.1.jns121696
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发表时间：
2013-06-01
影响因子：
4.1
通讯作者：
Bunevicius, Robertas
中科院分区：
文献类型：
--
作者：
Bunevicius, Adomas;Deltuva, Vytenis;Bunevicius, Robertas
对象。低三碘甲状腺原氨酸（T3）状态在危重患者中非常普遍，并与预后不良相关。作者调查了接受脑肿瘤手术的患者围手术期低T3综合征与临床结果、抑郁和焦虑症状的直接关系。90例因脑肿瘤手术入院的连续患者（71%为女性，中位年龄55岁），评估其社会人口学和临床特征。在脑肿瘤手术当天早上和手术后第二天早上对患者的甲状腺功能进行评估。游离T3浓度为3.1 pmol/L或更低的患者被认为是低T3综合征。术前和术后采用医院焦虑和抑郁量表（HADS）评估患者的抑郁和焦虑症状，出院时采用格拉斯哥结局量表（GOS）评估患者的临床结局。脑肿瘤手术后，游离T3浓度降低（p < 0.001）， T3水平低的患者比例从38%上升到54% （p = 0.02）。术前（rho = 0.30, p = 0.004）和术后（rho = 0.33, p = 0.002）较低的游离T3浓度与出院时GOS评分较低相关。术前低T3综合征（OR 5.49, 95% CI 1.27 ~ 23.69, p = 0.02）和术后低T3综合征（OR 8.73, 95% CI 1.49 ~ 51.21, p = 0.02）在调整年龄、性别、脑肿瘤组织学诊断、术前功能损害、既往脑肿瘤治疗和抑郁症状后，均增加了出院时不良临床结局（GOS评分< 5）的风险。术前低T3综合征增加了术前抑郁亚量表评分>= 11;OR 4.12,95% CI 1.16-14.58, p = 0.03)的风险，但与社会人口统计学和临床因素无关，不会增加术后抑郁症状的风险。低T3综合征是不良临床结局和抑郁症状的一个强有力的独立预测因子，在接受脑肿瘤神经外科治疗的患者中应考虑其诊断和术前处理。
Object. A low triiodothyronine (T3) state is highly prevalent and is associated with a poor prognosis in critically ill patients. The authors investigated, in patients undergoing brain tumor surgery, the direct association of a perioperative low T3 syndrome with clinical outcomes and also with symptoms of depression and anxiety.Methods. Ninety consecutive patients (71% women, median age 55 years), on admission for brain tumor surgery, were evaluated for sociodemographic and clinical characteristics. Their thyroid function profile was assessed on the morning of brain tumor surgery and on the morning after brain tumor surgery. Patients with free T3 concentrations of 3.1 pmol/L or less were considered to have low T3 syndrome. The patients were evaluated for symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) before and after surgery and for clinical outcomes using the Glasgow Outcome Scale (GOS) at discharge.Results. After brain tumor surgery, free T3 concentrations decreased (p < 0.001) and the proportion of patients with low T3 levels increased from 38% to 54% (p = 0.02). Lower preoperative (rho = 0.30, p = 0.004) and postoperative (rho = 0.33, p = 0.002) free T3 concentrations correlated with low GOS scores at discharge. Preoperative low T3 syndrome (OR 5.49, 95% CI 1.27-23.69, p = 0.02) and postoperative low T3 syndrome (OR 8.73, 95% CI 1.49-51.21, p = 0.02) both increased risk for unfavorable clinical outcomes (GOS scores < 5) at discharge, after adjusting for age, sex, histological diagnosis of brain tumor, preoperative functional impairment, previous treatment for brain tumor, and depressive symptoms. Preoperative low T3 syndrome increased the risk for preoperative (HADS-depression subscale score >= 11; OR 4.12,95% CI 1.16-14.58, p = 0.03) but not postoperative depressive symptoms independently from sociodemographic and clinical factors.Conclusions. Low T3 syndrome is a strong independent predictor of unfavorable clinical outcomes and depressive symptoms, and its diagnosis and preoperative management should be considered in patients undergoing neurosurgery for the treatment of brain tumors.