Background

Non-thyroidal illness syndrome (NTIS) develops in a large proportion of critically ill patients and is associated with high risk for death. We aimed to investigate the correlation between NTIS and liver failure, and the short-term mortality of patients with these conditions.

Methods

The clinical data of 87 patients with liver failure were collected retrospectively, 73 of them were randomly selected for an observational study and to establish prognostic models, and 14 for model validation. Another 73 sex- and age-matched patients with mild chronic hepatitis were randomly selected as a control group. Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were measured. The clinical characteristics of patients with liver failure and NTIS were analyzed. The follow-up of patients lasted for 3 months. Additionally, the values for predicting short-term mortality of model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP), chronic liver failure-sequential organ failure assessment (CLIF-SOFA) scores, FT3-MELD model, and FT3 were evaluated.

Results

The observation group had significantly lower FT3 (2.79 ± 0.71 vs. 4.43 ± 0.75 pmol/L, P < 0.001) and TSH [0.618 (0.186-1.185) vs. 1.800 (1.570-2.590) mIU/L, P < 0.001], and higher FT4 (19.51 ± 6.26 vs. 14.47 ± 2.19 pmol/L, P <0.001) than the control group. NTIS was diagnosed in 49 of the patients with liver failure (67.12%). In the observation group, patients with NTIS had a higher mortality rate than those without (63.27% vs. 25.00%, P = 0.002). Across the whole cohort, the 3-month mortality was 50.68%. The international normalized ratios (INR) were 2.40 ± 1.41 in survivors and 3.53 ± 1.81 in deaths (P = 0.004), the creatinine (Cr) concentrations were 73.27 ± 36.94 µmol/L and 117.08 ± 87.98 µmol/L (P = 0.008), the FT3 concentrations were 3.13 ± 0.59 pmol/L and 2.47 ± 0.68 pmol/L (P < 0.001), the MELD scores were 22.19 ± 6.64 and 29.57 ± 7.99 (P < 0.001), the CTP scores were 10.67 ± 1.53 and 11.78 ± 1.25 (P = 0.001), and the CLIF-SOFA scores were 8.42 ± 1.68 and 10.16 ± 2.03 (P < 0.001), respectively. FT3 was negatively correlated with MELD score (r = −0.430, P < 0.001). An FT3-MELD model was established by subjecting FT3 concentration and MELD score to logistic regression analysis using the following formula: Logit(P) = −1.337 × FT3+0.114 × MELD+0.880. The area under the receiver operating characteristic (ROC) curve was 0.827 and the optimal cut-off value was 0.4523. The corresponding sensitivity and specificity were 67.6% and 91.7%. The areas under the ROC curve for FT3 concentration, MELD score, CTP score, and CLIF-SOFA score were 0.809, 0.779, 0.699, and 0.737, respectively.

Conclusions

Patients with liver failure often develop NTIS. FT3-MELD score perform better than CTP and CLIF-SOFA scores in predicting mortality in patients with liver failure. Thus, the FT3-MELD model could be of great value for the evaluation of the short-term mortality of such patients.

中文翻译：

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肝功能衰竭患者甲状腺功能的变化及其临床意义：肝功能衰竭患者非甲状腺疾病综合征的临床研究[J].

背景

非甲状腺疾病综合征 (NTIS) 在很大比例的危重患者中发生，并且与高死亡风险相关。我们旨在调查 NTIS 与肝功能衰竭之间的相关性，以及患有这些疾病的患者的短期死亡率。

方法

回顾性收集87例肝功能衰竭患者的临床资料，随机选取73例进行观察性研究和建立预后模型，14例进行模型验证。另随机选取性别、年龄相匹配的轻度慢性肝炎患者73例作为对照组。测量血清游离三碘甲状腺原氨酸 (FT3)、游离甲状腺素 (FT4) 和促甲状腺激素 (TSH)。分析肝功能衰竭和NTIS患者的临床特征。对患者的随访持续了 3 个月。此外，终末期肝病模型（MELD）、Child-Turcotte-Pugh（CTP）、慢性肝衰竭-序贯器官衰竭评估（CLIF-SOFA）评分、FT3-MELD模型的短期死亡率预测值, 和 FT3 进行了评估。

结果

观察组FT3显着降低（2.79±0.71 vs. 4.43±0.75 pmol/L，P < 0.001）和TSH [0.618 (0.186-1.185) vs. 1.800 (1.570-2.590) mIU/L, P < 0.001] FT4 (19.51 ± 6.26 vs. 14.47 ± 2.19 pmol/L, P < 0.001) 高于对照组。49 名肝功能衰竭患者 (67.12%) 被诊断出 NTIS。在观察组中，NTIS 患者的死亡率高于非 NTIS 患者（63.27% vs. 25.00%，P = 0.002）。在整个队列中，3 个月的死亡率为 50.68%。幸存者的国际标准化比率 (INR) 为 2.40 ± 1.41，死亡者为 3.53 ± 1.81 ( P = 0.004)，肌酐 (Cr) 浓度为 73.27 ± 36.94 µmol/L 和 117.08 ± 87.98 µmol/L (P = 0.008)，FT3 浓度分别为 3.13 ± 0.59 pmol/L 和 2.47 ± 0.68 pmol/L ( P <  0.001)，MELD 评分分别为 22.19 ± 6.64 和 29.57 ± 7.99 ( P <  0.001) ± 1.53 和 11.78 ± 1.25 ( P  = 0.001)，CLIF-SOFA 评分分别为 8.42 ± 1.68 和 10.16 ± 2.03 ( P  < 0.001)。FT3 与 MELD 评分呈负相关（r  = -0.430，P  < 0.001）。通过对FT3浓度和MELD评分进行逻辑回归分析，使用以下公式建立FT3-MELD模型：Logit( P) = −1.337 × FT3+0.114 × MELD+0.880。受试者工作特征 (ROC) 曲线下面积为 0.827，最佳临界值为 0.4523。相应的敏感性和特异性分别为67.6%和91.7%。FT3浓度、MELD评分、CTP评分和CLIF-SOFA评分的ROC曲线下面积分别为0.809、0.779、0.699和0.737。

结论

肝功能衰竭的患者经常会出现 NTIS。FT3-MELD 评分在预测肝功能衰竭患者死亡率方面优于 CTP 和 CLIF-SOFA 评分。因此，FT3-MELD 模型对于评估此类患者的短期死亡率具有重要价值。