Department of Endocrinology, Hospital Ramón y Cajal, Ctra. de colmenar, Km 9,100, 28034 Madrid, Spain.
J Clin Endocrinol Metab. 2013 Dec;98(12):4683-90. doi: 10.1210/jc.2012-3849. Epub 2013 Oct 30.
Several alterations in thyroid function test (TFT) results have been associated with mortality in elderly patients.
Our aim was to investigate the relationship between TFT results and all-cause and cardiovascular (CV) mortality in aged hospitalized patients.
A 7-year prospective observational study was conducted. TFTs were performed at hospital admission, and mortality was registered in the follow-up period.
Participants were 404 patients aged >65 years admitted to the Department of Geriatrics, Hospital General, Segovia, Spain, for any reason during 2005.
The study evaluated the association between TFT results and mortality from all causes and CV diseases.
TSH, free T₄, and free T₃ (FT₃) were measured on the first day of admission. In-hospital and total survival times, number of deaths, and all-cause and CV mortality were registered until the census date on January 1, 2012.
During the study, 323 patients (80%) died. Kaplan-Meier analysis showed that median survival time for all-cause mortality was significantly lower in patients in the first tertile of serum FT₃, in the first tertile of TSH, and in the first tertile of serum free T₄ concentrations. Multivariate adjusted Cox regression analysis showed that the history of cancer (hazard ratio, 1.60; 95% confidence interval, 1.12-2.28; P = .009), age (1.03; 1.01-1.06; P = .003), and FT₃ levels (0.72; 0.63-0.84; P < .001) were significant factors related to all-cause mortality. The cause of death was known in 202 patients. Of this group, 61 patients (30.2%) died of CV disease. Patients in the first tertile of TSH and FT₃ exhibited a significant higher mortality due to CV disease. In the adjusted Cox regression analysis, FT₃ was a significant predictor of CV mortality (0.76; 0.63-0.91; P = .004).
Alterations in TFT results during hospitalization are associated with long-term mortality in elderly patients. In particular, low FT₃ levels are significantly related to all-cause and CV mortality.
甲状腺功能测试（TFT）结果的几种改变与老年患者的死亡率有关。
我们旨在研究TFT 结果与老年住院患者全因和心血管（CV）死亡率之间的关系。
进行了一项为期 7 年的前瞻性观察研究。在入院时进行 TFT 检查，并在随访期间登记死亡率。
2005 年期间，因任何原因入住西班牙塞哥维亚总医院老年科的 404 名年龄>65 岁的患者参加了该研究。
该研究评估了 TFT 结果与全因和 CV 疾病死亡率之间的关系。
在入院的第一天测量 TSH、游离 T₄ 和游离 T₃（FT₃）。登记住院和总生存时间、死亡人数以及全因和 CV 死亡率，直至 2012 年 1 月 1 日的人口普查日期。
在研究期间，323 名患者（80%）死亡。Kaplan-Meier 分析表明，FT₃、TSH 和游离 T₄ 浓度第一三分位的患者全因死亡率的中位生存时间明显更低。多变量调整后的 Cox 回归分析显示，癌症病史（危险比，1.60；95%置信区间，1.12-2.28；P=.009）、年龄（1.03；1.01-1.06；P=.003）和 FT₃ 水平（0.72；0.63-0.84；P<.001）是全因死亡率的显著相关因素。在 202 名已知死因的患者中，61 名（30.2%）死于 CV 疾病。TSH 和 FT₃ 第一三分位的患者死于 CV 疾病的死亡率显著更高。在调整后的 Cox 回归分析中，FT₃ 是 CV 死亡率的显著预测因素（0.76；0.63-0.91；P=.004）。
住院期间 TFT 结果的改变与老年患者的长期死亡率相关。特别是，FT₃ 水平降低与全因和 CV 死亡率显著相关。
