Non-thyroidal illness syndrome and isolated low triiodothyronine as prognostic markers in acute illness: a systematic review and meta-analysis.

IF 3.3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2026-09-28 DOI:10.1007/s12020-026-04772-8

Elisa Gatta, Virginia Maltese, Enrico Papini, Rinaldo Guglielmi, Roberto Negro, Massimo Salvetti, Carlo Cappelli

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Abstract

Purpose: To evaluate the association between thyroid hormone alterations and mortality in critically ill and cardiovascular patients, and to compare the prognostic performance of non-thyroidal illness syndrome and isolated low triiodothyronine.

Methods: PubMed/MEDLINE, Scopus, and Web of Science were systematically searched for studies published between 2014 and 2026 evaluating thyroid dysfunction and mortality in acute or critical illness. Studies assessing non-thyroidal illness syndrome or isolated low triiodothyronine were included. Random-effects meta-analyses were performed using odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Twenty-two studies were included. Fifteen studies evaluating non-thyroidal illness syndrome (5,230 patients) showed a significant association with mortality (OR 3.19, 95% CI 2.10-4.85), although heterogeneity was substantial (I²=67.5%, p<0.0001). Nine studies evaluating isolated low triiodothyronine (6,282 patients) also demonstrated a significant association with mortality (OR 2.93, 95% CI: 2.04-4.20), with substantial heterogeneity (I²=63.8%, p = 0.0048). Subgroup comparison and exploratory meta-regression showed no significant differences in effect size between the two definitions of thyroid dysfunction.

Conclusions: Both non-thyroidal illness syndrome and isolated low triiodothyronine are associated with increased mortality in critically ill and cardiovascular patients. Although current aggregate data do not demonstrate a clear quantitative superiority of one definition over the other, non-thyroidal illness syndrome may provide a more integrated biological framework for interpreting thyroid dysfunction during acute illness.

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非甲状腺疾病综合征和孤立的低三碘甲状腺原氨酸作为急性疾病的预后标志物：一项系统回顾和荟萃分析

目的：探讨危重症和心血管患者甲状腺激素变化与死亡率的关系，并比较非甲状腺疾病综合征和孤立性低三碘甲状腺原氨酸的预后。方法：系统检索PubMed/MEDLINE、Scopus和Web of Science在2014年至2026年间发表的评估急性或危重疾病中甲状腺功能障碍和死亡率的研究。包括评估非甲状腺疾病综合征或孤立性低三碘甲状腺原氨酸的研究。随机效应荟萃分析采用比值比（ORs）和95%置信区间（ci）。结果：纳入22项研究。15项评估非甲状腺疾病综合征（5230例患者）的研究显示，非甲状腺疾病综合征与死亡率显著相关（OR 3.19, 95% CI 2.10-4.85），尽管异质性很大（I²=67.5%）。结论：非甲状腺疾病综合征和孤立的低三碘甲状腺原氨酸与危重症和心血管患者死亡率增加相关。尽管目前的总体数据并不能证明一种定义比另一种定义有明确的定量优势，但非甲状腺疾病综合征可能为解释急性疾病期间的甲状腺功能障碍提供了一个更综合的生物学框架。

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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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.