Vidart Josi, Jaskulski Paula, Kunzler Ana Laura, Marschner Rafael Aguiar, Ferreira de Azeredo da Silva André, Wajner Simone Magagnin
Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Endocr Connect. 2022 Feb 9;11(2):e210504. doi: 10.1530/EC-21-0504.
We performed a systematic review and meta-analysis to comprehensively determine the prevalence and the prognostic role of non-thyroidal illness syndrome (NTIS) in critically ill patients. We included studies that assessed thyroid function by measuring the serum thyroid hormone (TH) level and in-hospital mortality in adult septic patients. Reviews, case reports, editorials, letters, animal studies, duplicate studies, and studies with irrelevant populations and inappropriate controls were excluded. A total of 6869 patients from 25 studies were included. The median prevalence rate of NTIS was 58% (IQR 33.2-63.7). In univariate analysis, triiodothyronine (T3) and free T3 (FT3) levels in non-survivors were relatively lower than that of survivors (8 studies for T3; standardized mean difference (SMD) 1.16; 95% CI, 0.41-1.92; I2 = 97%; P < 0.01). Free thyroxine (FT4) levels in non-survivors were also lower than that of survivors (12 studies; SMD 0.54; 95% CI, 0.31-0.78; I2 = 83%; P < 0.01). There were no statistically significant differences in thyrotropin levels between non-survivors and survivors. NTIS was independently associated with increased risk of mortality in critically ill patients (odds ratio (OR) = 2.21, 95% CI, 1.64-2.97, I2 = 65% P < 0.01). The results favor the concept that decreased thyroid function might be associated with a worse outcome in critically ill patients. Hence, the measurement of TH could provide prognostic information on mortality in adult patients admitted to ICU.
我们进行了一项系统评价和荟萃分析，以全面确定非甲状腺疾病综合征（NTIS）在重症患者中的患病率及其预后作用。我们纳入了通过测量血清甲状腺激素（TH）水平评估甲状腺功能以及评估成年脓毒症患者院内死亡率的研究。排除了综述、病例报告、社论、信件、动物研究、重复研究以及研究人群不相关和对照不恰当的研究。共纳入了来自25项研究的6869例患者。NTIS的中位患病率为58%（四分位间距33.2 - 63.7）。在单因素分析中，非存活者的三碘甲状腺原氨酸（T3）和游离T3（FT3）水平相对低于存活者（关于T3的研究有8项；标准化均数差（SMD）1.16；95%置信区间，0.41 - 1.92；I² = 97%；P < 0.01）。非存活者的游离甲状腺素（FT4）水平也低于存活者（12项研究；SMD 0.54；95%置信区间，0.31 - 0.78；I² = 83%；P < 0.01）。非存活者和存活者之间促甲状腺激素水平无统计学显著差异。NTIS与重症患者死亡风险增加独立相关（优势比（OR） = 2.21，95%置信区间，1.64 - 2.97，I² = 65%，P < 0.01）。结果支持甲状腺功能降低可能与重症患者预后较差相关这一概念。因此，TH的测量可为入住重症监护病房的成年患者的死亡率提供预后信息。
