Hata Masahisa, Takahara Mitsuyoshi, Kubo Fumiyo, Fujita Yohei, Tamura Ryota, Takeda Saki, Katsura Takashi, Umayahara Yutaka, Hatazaki Masahiro
Department of Diabetes and Endocrinology, Osaka General Medical Center, Japan.
Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Japan.
Intern Med. 2025 Aug 1;64(15):2270-2275. doi: 10.2169/internalmedicine.4629-24. Epub 2024 Dec 26.
Objective The Glasgow Coma Scale (GCS) is widely used to assess the levels of consciousness. This study examined whether or not the initial GCS score could be a marker of the length of hospital stay (LOS) in patients with thyroid storm. Methods We retrospectively analyzed 29 patients with thyroid storm in our hospital between January 2010 and December 2023. Thyroid storm was diagnosed based on the latest diagnostic criteria in Japan. Since 30 days is the upper limit of LOS in the Diagnosis Procedure Combination [DPC]-based reimbursement system, the study population was divided into patients with permissible LOS (<30 days) and those with undesirable LOS (≥30 days). As a supplementary analysis, we examined the correlation of the GCS score and other clinical parameters with LOS using a Spearman's rank correlation analysis. Results The GCS score was significantly higher (14.1±2.7 vs. 9.9±4.9 points; p<0.001), and the Sequential Organ Failure Assessment (SOFA) score significantly lower (1.68±2.16 vs. 7.50±7.91 points; p=0.009) in patients with permissible LOS than in those with undesirable LOS, while other clinical parameters were not significantly different between the groups. The area under the receiver operating characteristic curve of the GCS for the permissible vs. undesirable LOS was 0.866. The baseline parameters that were significantly correlated with LOS were the GCS (ρ=-0.665; p<0.001) and SOFA score (ρ=0.670; p<0.001). The subsequent rank partial correlation analysis showed that GCS was still inversely correlated with LOS, independent of SOFA score (ρ=-0.390; p=0.040). Conclusion GCS, which can be evaluated more easily and quickly than the SOFA score, is a useful marker of LOS in patients with thyroid storm.
目的 格拉斯哥昏迷量表（GCS）被广泛用于评估意识水平。本研究旨在探讨甲状腺危象患者的初始GCS评分是否可作为住院时间（LOS）的标志物。方法 我们回顾性分析了2010年1月至2023年12月期间我院收治的29例甲状腺危象患者。甲状腺危象的诊断依据日本最新诊断标准。由于在基于诊断程序组合（DPC）的报销系统中，住院时间上限为30天，因此将研究人群分为住院时间允许组（<30天）和住院时间不理想组（≥30天）。作为补充分析，我们使用Spearman等级相关分析检验了GCS评分及其他临床参数与住院时间的相关性。结果 住院时间允许组患者的GCS评分显著更高（14.1±2.7分 vs. 9.9±4.9分；p<0.001），序贯器官衰竭评估（SOFA）评分显著更低（1.68±2.16分 vs. 7.50±7.91分；p=0.009），而两组间其他临床参数无显著差异。GCS区分住院时间允许组与不理想组的受试者工作特征曲线下面积为0.866。与住院时间显著相关的基线参数为GCS（ρ=-0.665；p<0.001）和SOFA评分（ρ=0.670；p<0.001）。随后的等级偏相关分析显示，独立于SOFA评分，GCS仍与住院时间呈负相关（ρ=-0.390；p=0.040）。结论 与SOFA评分相比，GCS评估更简便快捷，是甲状腺危象患者住院时间的有用标志物。
