Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia

Abstract

Low T3 syndrome was previously reported to be linked to poor clinical outcomes in critically ill patients. The aim of this study was to evaluate the predictive power of low T3 syndrome for clinical outcomes in patients with community-acquired pneumonia (CAP). Data for 503 patients were analyzed retrospectively, and the primary end point was 30-day mortality. The intensive care unit (ICU) admission rate and 30-day mortality were 8.3% and 6.4% respectively. The prevalence of low T3 syndrome differed significantly between survivors and nonsurvivors (29.1% vs 71.9%, P < 0.001), and low T3 syndrome was associated with a remarkable increased risk of 30-day mortality and ICU admission in patients with severe CAP. Multivariate logistic regression analysis produced an odds ratio of 2.96 (95% CI 1.14–7.76, P = 0.025) for 30-day mortality in CAP patients with low T3 syndrome. Survival analysis revealed that the survival rate among CAP patients with low T3 syndrome was lower than that in the control group (P < 0.01). Adding low T3 syndrome to the PSI and CURB-65 significantly increased the areas under the ROC curves for predicting ICU admission and 30-day mortality. In conclusion, low T3 syndrome is an independent risk factor for 30-day mortality in CAP patients.

Low T3 syndrome is a strong prognostic predictor in diffuse large B cell lymphoma

“…In previous epidemiological studies, the evidence indicated that low T3 syndrome was an independent prognostic factor in CKD (Fan et al , ), acute cerebrovascular disorders (Bunevicius et al , ), community acquired pneumonia (Liu et al , ), chronic heart failure (Chen et al , ) and haemodialysis patients (Fragidis et al , ). In consensus with our results, Fan et al () reported that serum T3 was positively related to protein metabolism (albumin) and anaemia indicators (Hb), and negatively related to inflammatory status (CRP).…”

“…In the last decade, substantial evidences have described the presence of low T3 syndrome in acute and prolonged critical illness, such as acute cerebrovascular disorders, septic shock, multiple trauma, severe burn, community‐acquired pneumonia, CKD, chronic liver failure and heart failure. The prevalence of low T3 syndrome was reported to be 47·0% in CKD (Fan et al , ), 56·6% in acute stroke (Alevizaki et al , ), 30·2% in cardiac disease (Iervasi et al , ), 30·7% in chronic haemodialysis (Fragidis et al , ) and 31·8% in community‐acquired pneumonia patients (Liu et al , ). Regarding malignancies, Yasar et al () found a low T3 syndrome incidence of 42·25% in non‐small cell lung cancer and 44·90% in small cell lung cancer, and the morbidity of low T3 syndrome was 16·50% in breast cancer (Huang et al , ).…”

“…Although low T3 syndrome can be seen as an adaptive mechanism to counteract excessive catabolism and support immune response during acute phase, it might exert disadvantages as critical illness enters a chronic phase, necessitating prolonged life support as confirmed in preclinical and clinical studies (Van den Berghe, ; Weekers et al , ). Several observational studies indicated that low T3 syndrome was an independent prognostic factor for seriously ill hospitalized patients, including those who had septic shock, multiple trauma, severe burn, acute cerebrovascular disorders, community‐acquired pneumonia, chronic kidney disease (CKD), chronic liver failure and heart failure (Gangemi et al , ; Du et al , ; Agiasotelli et al , ; Bunevicius et al , ; Chen et al , ; Fan et al , ; Liu et al , ). With regard to cancer risk and cancer mortality, an evident association was identified between low T3 syndrome and metastasized cancer in a hospitalized older population ( P = 0·0002) (Tognini et al , ).…”

Low T3 syndrome as a predictor of poor prognosis in chronic lymphocytic leukemia

“…In the last two decades, low T3 syndrome or low T3 state was reported to be highly prevalent in critically ill patients, with the incidence rate of 90.0% in severe trauma, 78.6% in end‐stage renal disease, 56.6% in acute stroke, 53.1% in respiratory failure, 31.8% in community‐acquired pneumonia and 30.2% in heart disease . For the presence of low T3 syndrome in malignancies, Bunevicius et al .…”

Low FT3 is a valuable predictor of severe acute pancreatitis in the emergency department

“…Clinical reports have shown that the metabolism of thyroid hormones is influenced by acute systemic illnesses, known as low triiodothyronine (T3) syndrome or nonthyroidal illness syndrome, with a phenotype of decreased serum levels of free triiodothyronine (FT3) with or without low levels of free tetraiodothyronine (FT4) and thyroid‐stimulating hormone (TSH) . Numerous studies have found that low T3 syndrome is associated with poor outcomes in critical illnesses, including septic shock, cerebrovascular crisis, respiratory failure, multiple trauma and severe burns . Nevertheless, there are insufficient data on the association between low T3 syndrome and the severity of AP.…”