Clinical Significance of Low-Triiodothyronine Syndrome in Patients Requiring Non-Surgical Intensive Care　― Triiodothyronine Is a Comprehensive Prognostic Marker for Critical Patients With Cardiovascular Disease ―

• Shigihara Shota

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Shirakabe Akihiro

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Kobayashi Nobuaki

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Okazaki Hirotake

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Matsushita Masato

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Shibata Yusaku

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Nishigoori Suguru

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Sawatani Tomofumi

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Okajima Fumitaka

  Department of Endocrinology, Nippon Medical School Chiba Hokusoh Hospital

• Asai Kuniya

  Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital

• Shimizu Wataru

  Department of Cardiovascular Medicine, Nippon Medical School

Abstract

Background:Low-triiodothyronine (T₃) syndrome is a known complication in intensive care unit (ICU) patients, but the underlying mechanisms and prognostic impact are unclear. Methods and Results:This study retrospectively enrolled 2,976 patients who required care in the ICU. Of these patients, 2,425 were euthyroid and were divided into normal (n=1,666; free T₃[FT₃] ≥1.88 µIU/L) and low-FT₃(n=759; FT₃<1.88 µIU/L) groups. Multivariate logistic regression analysis revealed that prognostic nutritional index >46.03 (odds ratio [OR] 2.392; 95% confidence interval [CI] 1.904–3.005), age (per 1-year increase; OR 1.022; 95% CI 1.013–1.031), creatinine (per 0.1-mg/dL increase; OR 1.019; 95% CI 1.014–1.024), and C-reactive protein (per 1-mg/dL increase; OR 1.123; 95% CI 1.095–1.151) were independently associated with low FT₃. Survival rates (within 365 days) were significantly lower in the low-FT₃group. A multivariate Cox regression model showed that low FT₃was an independent predictor of 365-day mortality (hazard ratio 1.785; 95% CI 1.387–2.297). Low-T₃syndrome was significantly more frequent in patients with non-cardiovascular than cardiovascular diseases (73.5% vs. 25.8%). Prognosis was significantly poorer in the low-FT₃than normal group for patients with cardiovascular disease, particularly those with acute coronary syndrome and acute heart failure. Conclusions:Low-T₃syndrome was associated with aging, inflammatory reaction, malnutrition, and renal insufficiency and could lead to adverse outcomes in patients admitted to a non-surgical ICU.

Journal

• Circulation Reports

  Circulation Reports advpub (0), 578-588, 2021-09-30

  The Japanese Circulation Society

Keywords

• Euthyroid sick syndrome
• Mortality
• Non-thyroidal illness

Details

• CRID: 1390008078424590592
• NII Article ID: 130008102381
• DOI: 10.1253/circrep.cr-21-0040
• ISSN: 24340790
• Web Site: https://www.jstage.jst.go.jp/article/circrep/3/10/3_CR-21-0040/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2022160326
• Text Lang: en
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed