血游离三碘甲状腺原氨酸水平可作为新型冠状病毒肺炎患者预后的预测指标
The prognostic value of free triiodothyronine for COVID-19 patients

赵惠.血游离三碘甲状腺原氨酸水平可作为新型冠状病毒肺炎患者预后的预测指标[J].内科急危重症杂志,2022,28(1):32-36

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DOI：10.11768/nkjwzzzz20220107

中文关键词: 严重急性呼吸综合征冠状病毒2 新型冠状病毒肺炎非甲状腺疾病综合征甲状腺激素预后

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作者	单位	E-mail
赵惠	华中科技大学同济医学院附属同济医院重症医学科	ysli@tjh.tjmu.edu.cn

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中文摘要:

目的：探讨非甲状腺疾病综合征（NTIS）对新型冠状病毒肺炎（COVID-19）患者的预后价值。方法：回顾性收集2020年1月14日-2月28日华中科技大学同济医学院附属同济医院收治确诊的COVID-19患者，根据游离三碘甲状腺原氨酸（FT3）值分为NTIS组(FT3<3.1pmol/L)和非NTIS组。采用Logistic回归分析和Kaplan-Meier曲线分析NTIS与COVID-19预后的相关性。绘制受试者工作特征（ROC）曲线以确定FT3对住院死亡率的预测性能。结果：共纳入384例患者，其中NTIS组92例和非NTIS组292例，与非NTIS组比较，NTIS组炎症反应强烈，凝血功能障碍复杂，心脏损伤及全身其他器官损伤较多，但淋巴细胞绝对值、百分比较低。Logistic回归分析显示,NTIS与COVID-19严重程度(aOR=3.795)、急性呼吸窘迫综合征并发症(aOR=3.768)和急性心脏损伤并发症(aOR=3.698),以及住院死亡率(aOR=5.017)独立相关。Kaplan-Meier曲线显示NTIS组患者生存趋势较差，风险比为5.98。ROC曲线显示FT3预测轻症患者住院死亡率的临界值为3.395pmol/L，重症/危重患者为3.035pmol/L。结论：NTIS与COVID-19患者的不良预后相关。FT3值可作为COVID-19患者死亡率的预测指标。

英文摘要:

Objective: To investigate the prognostic value of non-thyroid illness syndrome (NTIS) in patients with COVID-19. Methods: From January 14 to February 28, 2020, patients with confirmed critical COVID-19 in Tongji Hospital in Wuhan were retrospectively reviewed. Patients included were divided into two groups according to free triiodothyronine (FT3) values: the NTIS group(FT3<3.1 pmol/L) and the non-NTIS group. Logistic regression analysis and Kaplan-Meier curve were utilized to determine the association between NTIS and COVID-19. A ROC curve was plotted to determine the predictive performance of FT3 in in-hospital mortality. Results: A total of 92 and 292 COVID-19 patients respectively with and without NTIS were included. Compared to patients without NTIS, those with NTIS presented with robust inflammatory response, complex coagulation dysfunction, more cardiac injuries and other systemic injuries, but lower lymphocyte, lymphocyte percentage. Logistic regression revealed that NTIS was independently associated with severe/critical classification of COVID-19(aOR=3.795), unfavorable complications such as ARDS (aOR=3.768) and acute cardiac injury (aOR=3.698), death in hospital (aOR=5.017). The Kaplan-Meier survival curves suggested a trend of worse survival among patients with NTIS with a hazard ratio of 5.98. The ROC curve showed that the cut-off values of FT3 in predicting in-hospital mortality were 3.395 pmol/L for all patients and 3.035 pmol/L for severe/critical ones, respectively. Conclusion: NTIS is associated with poor prognosis in patients with COVID-19. The value of FT3 can be used as a predictor of mortality for COVID-19 patients.