Impact of Hypothyroidism and Heart Failure on Hospitalization Risk.
Impact of Hypothyroidism and Heart Failure on Hospitalization Risk.
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甲状腺功能减退症和心力衰竭对住院风险的影响。
DOI：
10.1089/thy.2017.0362
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Rhee,ConnieM
中科院分区：
文献类型：
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作者：
Ro,Kevin;Yuen,AlexanderD;Du,Lin;Ro,ClarissaC;Seger,Christian;Yeh,MichaelW;Leung,AngelaM;Rhee,ConnieM
背景：先前的研究表明，甲状腺功能减退与死亡率之间的关系取决于潜在的心血管风险。关于甲状腺功能减退与住院风险的关系，以及这些关系如何被心血管状态所改变，我们知之甚少。方法：本研究调查了1990年至2015年间在一家大型大学三级医疗中心接受治疗的患者的甲状腺状态（以血清促甲状腺素（TSH）定义）与住院风险的关系。甲状腺状态分为甲状腺功能减退和甲状腺功能亢进（TSH >分别为4.7和0.3-4.7 mIU/L）。采用多变量Cox模型检验甲状腺状态与住院风险之间的关系，并按心血管状态分层。结果：52,856例符合入选标准的患者中，49,791例（94.2%）有甲状腺功能亢进，3065例（5.8%）有甲状腺功能减退。在按充血性心力衰竭（CHF）状态分层的分析中，与甲状腺功能正常相比，甲状腺功能减退与CHF患者的住院风险相关（校正风险比[aHRs] = 1.86[置信区间（CI） 1.17-2.94], HR = 0.95 [CI 0.92-0.99], p= 0.006）。在考虑死亡作为竞争事件的敏感性分析中，潜在的冠状动脉疾病改变了甲状腺功能减退与住院治疗的关系，因此在冠状动脉疾病患者与非冠状动脉疾病患者之间观察到更强的相关性。在竞争风险分析中，甲状腺功能减退分别与脑血管疾病患者和非脑血管疾病患者住院风险的高低相关。结论：甲状腺功能减退与潜在心血管疾病患者较高的住院风险相关。需要进一步的研究来确定用替代疗法矫正甲状腺状态是否能改善这一人群的住院风险。
Background:Prior studies suggest that the relationship between hypothyroidism and mortality is dependent on underlying cardiovascular risk. Little is known about the association of hypothyroidism with hospitalization risk, and how these associations are modified by cardiovascular status.Methods:This study examined the association of thyroid status, defined by serum thyrotropin (TSH), with hospitalization risk among patients who received care at a large university-based tertiary care center between 1990 and 2015. Thyroid status was categorized as hypothyroidism versus euthyroidism (TSH >4.7 vs. 0.3–4.7 mIU/L, respectively). The relationship between thyroid status and hospitalization risk stratified by cardiovascular status was examined using multivariable Cox models.Results:Among 52,856 patients who met eligibility criteria, 49,791 (94.2%) had euthyroidism and 3065 (5.8%) had hypothyroidism. In analyses stratified by congestive heart failure (CHF) status, compared to euthyroidism, hypothyroidism was associated with higher risk of hospitalization in those with CHF but slightly lower risk in those without CHF (adjusted hazard ratio [aHRs] = 1.86 [confidence interval (CI) 1.17–2.94] and HR = 0.95 [CI 0.92–0.99], respectively;p= 0.006). In sensitivity analyses accounting for death as a competing event, underlying coronary artery disease modified the hypothyroidism–hospitalization relationship, such that stronger associations were observed among those with versus without coronary artery disease. In competing risk analyses, hypothyroidism was associated with higher versus lower risk of hospitalization among those with versus without cerebrovascular disease, respectively.Conclusions:Hypothyroidism is associated with higher hospitalization risk among patients with underlying cardiovascular disease. Future studies are needed to determine whether correction of thyroid status with replacement therapy ameliorates hospitalization risk in this population.