Department of Emergency, the First Affiliated Hospital of WenZhou Medical University, Wenzhou 325000, China.
Department of Computer Technology and Information Management, the First Affiliated Hospital of WenZhou Medical University, Wenzhou 325000, China.
Am J Emerg Med. 2021 Jul;45:42-47. doi: 10.1016/j.ajem.2021.02.014. Epub 2021 Feb 12.
Sepsis is a systemic inflammatory response syndrome with high mortality. There is an upward trend in sepsis prevalence and mortality worldwide. Early and accurate prediction of outcome in sepsis is important. There remains a great need to improve a reliable prognostic model for sepsis patients with widely available variables. The aim of this study was to explore the correlation between serum thyroid hormone levels and prognosis in sepsis patients.
Septic patients were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Factors that were found to contribute to the outcome in the uni-variate analysis at P value <0.1 were included in the multivariate. Multivariate analysis was performed by binary logistic regression analysis, which allows adjust for confounding factors. We combined an assessment of thyroid hormone and some variables together, which improve the accurate prediction of outcome. The accuracy of the test was assessed measuring the area under the ROC curve (AUROC).
A total of 929 eligible septic patients were included in the data analysis. Seventy hundred and three patients had a good functional outcome, whereas 226 patients had a bad functional outcome. Thyroxin (T) level was significantly decreased in patients with an unfavorable functional outcome as compared to patients with a favorable functional outcome (P < 0.01). Binary logistic regression analyses revealed that lower thyroxin concentrations on admission were associated with a risk for poor outcomes (OR 0.556, 95% CI 0.41-0.75; P < 0.01). In addition, in ROC curve analysis, the combined model AUROC was 0.82 for ICU survival, which was significantly higher than the AUROCs of original fT (0.65 and 0.65), T (0.71 and 0.71) and SAPSII (0.70 and 0.72) (all P < 0.05).
Low serum thyroxin levels can be a predictive marker of short-term outcome after sepsis. A combined model (fT, T and SAPSII score) can add significant additional predictive information to the clinical score of the SAPSII.
脓毒症是一种具有高死亡率的全身性炎症反应综合征。脓毒症的患病率和死亡率在全球呈上升趋势。早期准确预测脓毒症的结局非常重要。仍然需要改进一个可靠的预后模型，以预测脓毒症患者的预后，这个模型需要使用广泛可用的变量。本研究旨在探讨血清甲状腺激素水平与脓毒症患者预后的相关性。
从医疗信息监测器-强化治疗（MIMIC-III）数据库中确定脓毒症患者。单变量分析中 P 值 <0.1 的与结局相关的因素被纳入多变量分析。多变量分析采用二元逻辑回归分析，该分析可调整混杂因素。我们将甲状腺激素和一些变量结合在一起进行评估，以提高对结局的准确预测。通过测量 ROC 曲线下的面积（AUROC）来评估测试的准确性。
共纳入 929 名符合条件的脓毒症患者进行数据分析。703 名患者有良好的功能结局，而 226 名患者有不良的功能结局。与功能结局良好的患者相比，功能结局不良的患者的甲状腺素（T）水平显著降低（P <0.01）。二元逻辑回归分析显示，入院时较低的甲状腺素浓度与不良结局的风险相关（OR 0.556，95%CI 0.41-0.75；P <0.01）。此外，在 ROC 曲线分析中，联合模型的 ICU 生存率 AUROC 为 0.82，明显高于原始 fT（0.65 和 0.65）、T（0.71 和 0.71）和 SAPSII（0.70 和 0.72）的 AUROC（均 P <0.05）。
血清甲状腺素水平降低可作为脓毒症短期预后的预测标志物。联合模型（fT、T 和 SAPSII 评分）可在 SAPSII 临床评分的基础上增加显著的预测信息。
