Guo Zebin, Chen Jianxia, Xu Juan, Zhong Hanbin, Chen Rongxin
Department of Critical Care Medicine, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China.
Department of Transplantation, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China. Corresponding author: Chen Rongxin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 Jan;34(1):75-79. doi: 10.3760/cma.j.cn121430-20210518-00740.
To explore the association between levels of thyroid-stimulating hormone (TSH) on admission and prognosis of patients admitted to intensive care unit (ICU).
The data were collected from patients who were admitted to the ICU of the Beth Israel Deaconess Medical Center in the United States from 2001 to 2012 with available TSH test records within 24 hours after the ICU admission via the Medical Information Mart for Intensive Care-III v1.4 (MIMIC-III v1.4). Information including gender, age, ethnicity, type of admission, mechanical ventilation (MV) or renal replacement therapy (RRT) received on admission, comorbidities, and TSH test records within 24 hours after the ICU admission were collected. The sequential organ failure assessment (SOFA) score, simplified acute physiology score II (SAPS II) and the comorbidities index Elixhauser (SID30) score were calculated according to the parameters. The primary outcome was hospital mortality. Differences in baseline characteristics and prognosis were examined between patients with normal TSH levels and abnormal TSH levels which was determined according to a dichotomous variable provided by the data. Multivariable Logistic regression was used to analyze the association between TSH levels and prognosis after adjusting for confounding factors. A sensitivity analysis was conducted which categorized the study population as three groups (i.e., decreased, normal, and elevated TSH levels) using the range of 0.30-3.00 mU/L as the normal range of TSH.
A total of 3 425 ICU patients were enrolled in the study, of which 2 692 (78.60%) were with normal TSH and 733 (21.40%) were with abnormal TSH. There was no statistically significant difference in gender, age, ethnicity, type of admission and the ratio of MV between the normal TSH and abnormal TSH groups. Compared with normal TSH group, the patients in abnormal TSH had a higher SOFA, SAPS II and SID30 scores as well as the ratio of RRT [SOFA score: 4 (2, 7) vs. 4 (2, 6), SAPS II score: 38.02±13.76 vs. 36.53±13.75, SID30 score: 11 (4, 22) vs. 11 (0, 20), RRT ratio: 5.32% (39/733) vs. 3.49% (94/2 692), all P < 0.05]. The hospital mortality of patients in normal TSH was significantly higher than that of those in abnormal TSH [9.82% (72/733) vs. 5.94% (160/2 692), P < 0.01]. After adjusting for confounding factors, abnormal TSH was significantly associated with hospital mortality [odds ratio (OR) = 1.71, 95% confidence interval (95%CI) was 1.24-2.35, P = 0.001]. In the sensitivity analysis in which the range of 0.30-3.00 mU/L was used as the normal range of TSH, compared with normal TSH, decreased TSH (OR = 2.36, 95%CI was 1.40-3.97, P = 0.001) and elevated TSH (OR = 1.44, 95%CI was 1.05-1.98, P = 0.023) were both significantly associated with increased hospital mortality.
An abnormal level of TSH within 24 hours after admitted to ICU is an independent risk factor for hospital mortality among ICU patients.
探讨入住重症监护病房（ICU）患者入院时促甲状腺激素（TSH）水平与预后的关系。
收集2001年至2012年在美国贝斯以色列女执事医疗中心ICU住院且在入住ICU后24小时内有可用TSH检测记录的患者数据，通过重症监护医疗信息数据库-III v1.4（MIMIC-III v1.4）获取。收集的信息包括性别、年龄、种族、入院类型、入院时接受的机械通气（MV）或肾脏替代治疗（RRT）、合并症以及入住ICU后24小时内的TSH检测记录。根据参数计算序贯器官衰竭评估（SOFA）评分、简化急性生理学评分II（SAPS II）和合并症指数埃利克斯豪泽（SID30）评分。主要结局为医院死亡率。根据数据提供的二分变量确定TSH水平正常和异常的患者，比较两组患者的基线特征和预后差异。采用多变量Logistic回归分析在调整混杂因素后TSH水平与预后的关系。进行敏感性分析，将研究人群分为三组（即TSH水平降低、正常和升高），使用0.30 - 3.00 mU/L作为TSH的正常范围。
共纳入3425例ICU患者，其中2692例（78.60%）TSH水平正常，733例（21.40%）TSH水平异常。TSH正常组和异常组在性别、年龄、种族、入院类型和MV比例方面无统计学显著差异。与TSH正常组相比，TSH异常组患者的SOFA、SAPS II和SID30评分以及RRT比例更高[SOFA评分：4（2，7）对4（2，6），SAPS II评分：38.02±13.76对36.53±13.75，SID30评分：11（4，22）对11（0，20），RRT比例：5.32%（39/733）对3.49%（94/2692），均P < 0.05]。TSH正常组患者的医院死亡率显著高于TSH异常组[9.82%（72/733）对5.94%（160/2692），P < 0.01]。调整混杂因素后，TSH异常与医院死亡率显著相关[比值比（OR） = 1.71，95%置信区间（95%CI）为1.24 - 2.35，P = 0.001]。在以0.30 - 3.00 mU/L作为TSH正常范围的敏感性分析中，与TSH正常相比，TSH降低（OR = 2.36，95%CI为1.40 - 3.97，P = 0.001）和TSH升高（OR = 1.44，95%CI为1.05 - 1.98，P = 0.023）均与医院死亡率增加显著相关。
入住ICU后24小时内TSH水平异常是ICU患者医院死亡的独立危险因素。
