Hong Jing, Liu Wen-Yue, Hu Xiang, Chen Wen-Wen, Jiang Fei-Fei, Xu Ze-Ru, Shen Fei-Xia, Zhu Hong
Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
Department of Geriatrics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 Feb 18;15:467-476. doi: 10.2147/DMSO.S354754. eCollection 2022.
Free triiodothyronine (FT3) and FT3/free thyroxine (FT4) ratio have been associated with mortality in various diseases. However, no study to date has identified a link between FT3, FT3/FT4 ratio and all-cause mortality in patients with diabetic foot ulcers (DFUs). This study aimed to investigate this relationship.
This retrospective cohort study included 726 patients diagnosed with DFUs in a public hospital from January 2015 to October 2019. Patients were classified by the optimal cut-off values of the FT3 and FT3/FT4 ratio, respectively. The association of FT3 and FT3/FT4 ratio with all-cause mortality was evaluated in a multivariable cox regression model. Directed acyclic graphs were used to assess the minimally sufficient sets of confounding variables.
Log rank tests indicated that patients with low FT3 and FT3/FT4 ratio had lower overall survival rates (all p < 0.001). The adjusted HRs for all-cause mortality were 0.48 (95% CI: 0.32-0.73, P = 0.001) when comparing high versus low FT3 and 0.47 (95% CI: 0.32-0.70, P < 0.001) when comparing high versus low FT3/FT4 ratio. Subgroup analyses showed that these associations existed only in elderly patients (≥65 years) and women, after adjustment. In men, only high FT3/FT4 ratio was associated with low all-cause mortality, after adjustment.
Routine assessment of FT3 and FT3/FT4 ratio may be a simple and effective way to identify high-risk patients with DFUs, especially in elderly patients and women.
游离三碘甲状腺原氨酸（FT3）及FT3/游离甲状腺素（FT4）比值与多种疾病的死亡率相关。然而，迄今为止尚无研究证实FT3、FT3/FT4比值与糖尿病足溃疡（DFU）患者的全因死亡率之间存在关联。本研究旨在探究这种关系。
这项回顾性队列研究纳入了2015年1月至2019年10月期间在一家公立医院被诊断为DFU的726例患者。分别根据FT3及FT3/FT4比值的最佳截断值对患者进行分类。在多变量Cox回归模型中评估FT3及FT3/FT4比值与全因死亡率的关联。采用有向无环图评估混杂变量的最小充分集。
对数秩检验表明，FT3及FT3/FT4比值较低的患者总生存率较低（所有p<0.001）。比较高FT3与低FT3时，全因死亡率的调整后HR为0.48（95%CI：0.32 - 0.73，P = 0.001）；比较高FT3/FT4比值与低FT3/FT4比值时，调整后HR为0.47（95%CI：0.32 - 0.70，P<0.001）。亚组分析显示，调整后这些关联仅存在于老年患者（≥65岁）和女性中。在男性中，调整后仅高FT3/FT4比值与低全因死亡率相关。
常规评估FT3及FT3/FT4比值可能是识别DFU高危患者的一种简单有效的方法，尤其是在老年患者和女性中。
