Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
Department of Neurology, The 3rd Hospital of Shijiazhuang, Shijiazhuang, 050011, Hebei Province, China.
Eur Geriatr Med. 2023 Apr;14(2):363-371. doi: 10.1007/s41999-023-00761-6. Epub 2023 Mar 22.
Older patients with non-thyroidal illness syndrome (NTIS) have a poor prognosis. However, there are few studies on the association of NTIS and mortality among older inpatients on general wards. In a 7-year retrospective observational study, we aimed to investigate the clinical features of NTIS and the association of NTIS and all-cause mortality in older inpatients.
A total of 959 older male inpatients whose average age was 86.3 ± 8.1 years were enrolled and divided into the NTIS group and non-NTIS group. Cox models were performed to explore the association of thyroid hormone level and mortality.
Patients had more respiratory disease and chronic kidney disease in the NTIS than in the non-NTIS group, especially in primary nursing care, respiratory failure and haemodialysis patients; serum total protein, albumin, prealbumin, haemoglobin, uric acid and high-density lipoprotein cholesterol levels were lower, and urea nitrogen and fasting blood glucose levels were higher, in the NTIS than in the non-NTIS group. Patients in the NTIS group had a lower survival rate over 7 years follow-up (P < 0.01). A lower free T level was associated with all-cause mortality with a HR of 1.50 (1.36, 1.66). Lower free T level was associated with reduced all-cause mortality with a HR of 0.91 (0.88, 0.94) even after adjusting for confounding factors (P < 0.01).
Among older male inpatients, the survival rate was lower in the NTIS group. A reduced free T level with low albumin and Hb levels was associated with all-cause mortality; moreover, a higher free T in the normal range may be a strong predictor for long-term mortality risk in hospitalised older male patients.
患有非甲状腺疾病综合征（NTIS）的老年患者预后较差。然而，关于 NTIS 与普通病房老年住院患者死亡率之间的关系的研究较少。在一项为期 7 年的回顾性观察研究中，我们旨在研究 NTIS 的临床特征以及 NTIS 与老年住院患者全因死亡率之间的关系。
共纳入 959 名平均年龄为 86.3±8.1 岁的老年男性住院患者，将其分为 NTIS 组和非 NTIS 组。采用 Cox 模型探讨甲状腺激素水平与死亡率的关系。
与非 NTIS 组相比，NTIS 组患者的呼吸系统疾病和慢性肾脏病更多，尤其是在初级护理、呼吸衰竭和血液透析患者中；NTIS 组血清总蛋白、白蛋白、前白蛋白、血红蛋白、尿酸和高密度脂蛋白胆固醇水平较低，尿素氮和空腹血糖水平较高。在 7 年的随访中，NTIS 组患者的生存率较低（P<0.01）。较低的游离 T 水平与全因死亡率相关，HR 为 1.50（1.36，1.66）。即使在调整了混杂因素后，较低的游离 T 水平与全因死亡率降低相关，HR 为 0.91（0.88，0.94）（P<0.01）。
在老年男性住院患者中，NTIS 组的生存率较低。低白蛋白和 Hb 水平的游离 T 减少与全因死亡率相关；此外，正常范围内较高的游离 T 可能是预测住院老年男性患者长期死亡率风险的一个有力指标。
