Long-term prognostic value of thyroid hormone levels in chronic critical illness patients.

Annals of medicine Pub Date : 2025-12-01 Epub Date: 2025-03-21 DOI:10.1080/07853890.2025.2479583
Zhaoxiang Li, Liang Wang, Jianling Shi, Weiying Han, Chengrui Zhu, Tingrui Zhang, Xiaochun Ma, Yingjian Liang
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Abstract

Background: Chronic critical illness (CCI) can manifest as dysfunction of thyroid hormones. This study aimed to investigate the predictive value of the nonthyroidal illness syndrome (NTIS) for the prognosis of CCI patients, establish a predictive model for the prognosis of CCI patients, and evaluate the efficacy of the model to provide a theoretical basis for clinical intervention.

Methods: This was a prospective observational study in which patients ≥18 years old who met the CCI criteria were enrolled. The primary outcome of the study was 90-day mortality after intensive care unit (ICU) admission. A nomogram was constructed to predict the prognosis of CCI patients, and the model was evaluated via the concordance index, calibration curve and decision curve analysis.

Results: A total of 545 patients were included, and NTIS patients accounted for 65.3% of the patients. CCI patients with NTIS had more ventilator days and higher 90-day mortality. Lower free triiodothyronine (FT3) levels (<1.19 pmol/L) or reduced free thyroxine (FT4) levels (<9.655 pmol/L) were significantly associated with reduced survival in CCI patients with NTIS. Older age, a higher Sequential Organ Failure Assessment (SOFA) score, an emergency other than a traumatic operation, and a lower FT4 and thyroid-stimulating hormone level were found to be independent prognostic factors for a fatal outcome in CCI patients. The C-index for the prediction nomogram was 0.734, and the bias-corrected C-index was 0.727. The area under the receiver operating characteristic curve of our prediction model was superior to that of the SOFA and Acute Physiology and Chronic Health Evaluation II scores.

Conclusions: Decreased serum FT3 and FT4 concentrations in patients with CCI at admission to the ICU on day 10 are associated with 90-day mortality. Early detection of serum FT3 and FT4 levels could help clinicians target CCI patients at high risk of clinical deterioration.

背景:慢性危重症(CCI)可表现为甲状腺激素功能紊乱。本研究旨在探讨非甲状腺疾病综合征(NTIS)对CCI患者预后的预测价值,建立CCI患者预后预测模型,并评估该模型的有效性,为临床干预提供理论依据:这是一项前瞻性观察研究,研究对象为年龄≥18 岁、符合 CCI 标准的患者。研究的主要结果是入住重症监护室(ICU)后 90 天的死亡率。研究人员构建了预测CCI患者预后的提名图,并通过一致性指数、校准曲线和决策曲线分析对模型进行了评估:结果:共纳入 545 例患者,其中 NTIS 患者占 65.3%。患有 NTIS 的 CCI 患者使用呼吸机的天数更多,90 天死亡率更高。游离三碘甲状腺原氨酸(FT3)水平(4)较低,预测提名图的 C 指数为 0.734,偏差校正 C 指数为 0.727。我们的预测模型的接收器操作特征曲线下面积优于 SOFA 和急性生理学和慢性健康评估 II 评分:结论:CCI 患者在入住重症监护室第 10 天时血清 FT3 和 FT4 浓度降低与 90 天死亡率有关。早期检测血清FT3和FT4水平有助于临床医生锁定临床恶化风险高的CCI患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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