Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis.
Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis.
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DOI：
10.4103/ijciis.ijciis_29_17
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发表时间：
2018-07
影响因子：
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通讯作者：
Jagati S
中科院分区：
文献类型：
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作者：
Padhi R;Kabi S;Panda BN;Jagati S
本研究旨在调查非甲状腺疾病综合征 (NTIS) 与成人脓毒症患者 28 天死亡率之间的关系。我们对成年脓毒症患者进行了前瞻性观察分析。比较28天幸存者和非幸存者的人口统计数据、合并症、入院时的血液检查结果（包括甲状腺激素分析）、急性生理和慢性健康评估II评分以及序贯器官衰竭评估评分。进一步将患者分为3组；非NTIS、NTIS A组（低总三碘甲状腺原氨酸（T3）和NTIS B组（低T3伴低甲状腺素（T4））。采用多变量Cox比例风险回归分析确定死亡危险因素。共纳入360例患者，总死亡率为30%。非NTIS患者死亡率为13.4%；A组为50.1%，B组69.1% (P < .001)。非幸存者和幸存者的中位 T3 (IQR) 分别为 0.74 (0.56–1.17) 和 1.58 (0.91–2.13)，中位游离 T3 (IQR) 2.40 (1.13-3.01) 和 4.03 (3.03-7.13) (P <在 Cox 比例风险分析中，NTIS 组 A（风险比，1.66；95% 置信区间 [CI]，1.00-2.76）和 B 组（风险比，2.57；95% CI，1.53-4.34）。NTIS 组的受试者工作曲线下面积为 0.68（95% CI， 0.63-0.72）。与幸存者相比，非幸存者的 T3 和游离 T3 显着降低，并且低 T3 和低 T4 的组合比单独低 T3 与更高的死亡率相关。较低的游离 T3 与 28 天死亡率独立相关。
This study was performed to investigate the association of non-thyroidal illness syndrome (NTIS) with 28-day mortality in adults with sepsis. We performed a prospective observational analysis of adult patients with sepsis. Patients' demographic data, comorbidities, the blood test results including thyroid hormone analysis at admission, Acute Physiologic and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score were compared between 28-day survivors and non-survivors. Further patients were divided into 3 groups; non-NTIS, NTIS group A (low total tri-iodothyronine (T3) and NTIS group B (low T3 with low thyroxine (T4). Multivariate Cox proportional hazards regression analysis was performed to determine the risk factors for mortality. A total of 360 patients were included, and overall mortality was 30%. The mortality of non-NTIS patients was 13.4%; group A, 50.1%, and group B 69.1% (P < .001). The median T3 (IQR) in non-survivors and survivors was 0.74 (0.56–1.17) and1.58 (0.91–2.13) and median free T3 (IQR) 2.40 (1.13-3.01) and 4.03 (3.03-7.13) respectively (P < .001). In Cox proportional hazards analysis, NTIS group A (hazard ratio, 1.66; 95% confidence interval [CI], 1.00-2.76) and group B (hazard ratio, 2.57; 95% CI, 1.53-4.34). The area under the receiver-operating curve of NTIS groups was 0.68 (95% CI, 0.63-0.72). The T3 and free T3 were significantly lower in non-survivors compared with that in survivors and that a combination of low T3 with low T4 was associated with greater mortality than low T3 alone. A lower free T3 is independently associated with 28-day mortality.