Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Front Endocrinol (Lausanne). 2024 Aug 2;15:1387845. doi: 10.3389/fendo.2024.1387845. eCollection 2024.
Thyroid hormones significantly influence cardiovascular pathophysiology, yet their prognostic role in acute aortic dissection (AAD) remains inadequately explored. This study assesses the prognostic value of thyroid hormone levels in AAD, focusing on the mediating roles of renal function and coagulation.
We included 964 AAD patients in this retrospective cohort study. Utilizing logistic regression, restricted cubic splines, and causal mediation analysis, we investigated the association between thyroid hormones and in-hospital mortality and major adverse cardiovascular events (MACEs).
In AAD patients overall, an increase of one standard deviation in FT4 levels was associated with a 31.9% increased risk of MACEs (OR 1.319; 95% CI 1.098-1.584) and a 36.1% increase in in-hospital mortality (OR 1.361; 95% CI 1.095-1.690). Conversely, a higher FT3/FT4 ratio was correlated with a 20.2% reduction in risk of MACEs (OR 0.798; 95% CI 0.637-0.999). This correlation was statistically significant predominantly in Type A AAD, while it did not hold statistical significance in Type B AAD. Key renal and coagulation biomarkers, including blood urea nitrogen, creatinine, cystatin C, prothrombin time ratio, prothrombin time, and prothrombin time international normalized ratio, were identified as significant mediators in the interplay between thyroid hormones and MACEs. The FT3/FT4 ratio exerted its prognostic influence primarily through the mediation of renal functions and coagulation, while FT4 levels predominantly impacted outcomes via a partial mediation effect on coagulation.
FT4 levels and the FT3/FT4 ratio are crucial prognostic biomarkers in AAD patients. Renal function and coagulation mediate the association between the thyroid hormones and MACEs.
甲状腺激素对心血管病理生理学有显著影响，但它们在急性主动脉夹层（AAD）中的预后作用仍未得到充分探索。本研究评估了甲状腺激素水平在 AAD 中的预后价值，重点关注肾功能和凝血的中介作用。
我们纳入了这项回顾性队列研究中的 964 名 AAD 患者。我们利用逻辑回归、限制立方样条和因果中介分析，研究了甲状腺激素与住院期间死亡率和主要不良心血管事件（MACE）之间的关系。
在 AAD 患者中，FT4 水平每增加一个标准差，MACE 的风险增加 31.9%（OR 1.319；95% CI 1.098-1.584），住院期间死亡率增加 36.1%（OR 1.361；95% CI 1.095-1.690）。相反，较高的 FT3/FT4 比值与 MACE 风险降低 20.2%相关（OR 0.798；95% CI 0.637-0.999）。这种相关性在 A 型 AAD 中具有统计学意义，而在 B 型 AAD 中则没有统计学意义。关键的肾功能和凝血生物标志物，包括血尿素氮、肌酐、胱抑素 C、凝血酶原时间比值、凝血酶原时间和凝血酶原时间国际标准化比值，被确定为甲状腺激素与 MACE 之间相互作用的重要中介物。FT3/FT4 比值主要通过肾功能和凝血的中介作用发挥其预后影响，而 FT4 水平主要通过对凝血的部分中介作用影响结局。
FT4 水平和 FT3/FT4 比值是 AAD 患者重要的预后生物标志物。肾功能和凝血中介了甲状腺激素与 MACE 之间的关联。
