Thyroid hormone disorders: a predictor of mortality in patients with septic shock defined by Sepsis-3?

Liu, Yan-Cun; Jiang, Tianyu; Chen, Zhen-Sen; Qi, Anlong; Gao, Yulei; Li, Shixin; Yu, Muming; Chai, Yifeng; Shou, Songtao

doi:10.1007/s11739-020-02546-2

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…In the pooled analysis, the recommended threshold for identifying the high level of blood lactate varied across the included studies. Nine studies set a cut-off value for high level blood lactate below 2 mmol/L [33,38,41,85,103,108,124,135,140], while 36 studies recognized the cut-off values for high level blood lactate between 2 and 4 mmol/L [6,11,15,16,34,35,39,43,50,52,53,64- In the pooled analysis, the recommended threshold for identifying the high level of blood lactate varied across the included studies. Nine studies set a cut-off value for high level blood lactate below 2 mmol/L [33,38,41,85,103,108,124,135,140], while 36 studies recognized the cut-off values for high level blood lactate between 2 and 4 mmol/L [6,11,15,16,34,35,39,43,50,52,53,[64][65][66][67][69][70][71][72]76,77,89,94,100,102,…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the presence of asymmetric distribution in funnel plots, as indicated by Deek's test (p = 0.00), raised the possibility of publication bias within the studies (Figure 5). sis between blood lactate levels and mortality [11,15,31,33,34,38,[43][44][45]50,53,56,59,[64][65][66][67][69][70][71][72]77,78,85,89,100,102,103,[106][107][108]110,111,114,117,121,122,124,[133][134][135][136][137][138][139][140].…”

Section: High Level Blood Lactate Demonstrated a Sufficient Prognosti...mentioning

confidence: 99%

“…As the blood lactate level could indicate the prognosis of sepsis, we a empt to underline whether the value of blood lactate was correlated different outcomes of sepsis (sepsis, severe sepsis and septic shock). For that, network meta-analysis was used to compare the average blood lactate values among non-septic patients, septic patients, severe septic patients and septic shock patients with frequentist statistics (Supplementary Figure [11,15,31,33,34,38,[43][44][45]50,53,56,59,[64][65][66][67][69][70][71][72]77,78,85,89,100,102,103,[106][107][108]110,111,114,117,121,122,124,[133][134][135][136][137][138][139][140].…”

Section: Blood Lactate Levels Failed To Distinguish Sepsis Severe Sep...mentioning

confidence: 99%

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Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

Zhu,

Zhou,

Qin

et al. 2024

Biomedicines

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Background: Blood lactate is a potentially useful biomarker to predict the mortality and severity of sepsis. The purpose of this study is to systematically review the ability of lactate to predict hierarchical sepsis clinical outcomes and distinguish sepsis, severe sepsis and septic shock. Methods: We conducted an exhaustive search of the PubMed, Embase and Cochrane Library databases for studies published before 1 October 2022. Inclusion criteria mandated the presence of case–control, cohort studies and randomized controlled trials that established the association between before-treatment blood lactate levels and the mortality of individuals with sepsis, severe sepsis or septic shock. Data was analyzed using STATA Version 16.0. Results: A total of 127 studies, encompassing 107,445 patients, were ultimately incorporated into our analysis. Meta-analysis of blood lactate levels at varying thresholds revealed a statistically significant elevation in blood lactate levels predicting mortality (OR = 1.57, 95% CI 1.48–1.65, I2 = 92.8%, p < 0.00001). Blood lactate levels were significantly higher in non-survivors compared to survivors in sepsis patients (SMD = 0.77, 95% CI 0.74–0.79, I2 = 83.7%, p = 0.000). The prognostic utility of blood lactate in sepsis mortality was validated through hierarchical summary receiver operating characteristic curve (HSROC) analysis, yielding an area under the curve (AUC) of 0.72 (95% CI 0.68–0.76), accompanied by a summary sensitivity of 0.65 (95% CI 0.59–0.7) and a summary specificity of 0.7 (95% CI 0.64–0.75). Unfortunately, the network meta-analysis could not identify any significant differences in average blood lactate values’ assessments among sepsis, severe sepsis and septic shock patients. Conclusions: This meta-analysis demonstrated that high-level blood lactate was associated with a higher risk of sepsis mortality. Lactate has a relatively accurate predictive ability for the mortality risk of sepsis. However, the network analysis found that the levels of blood lactate were not effective in distinguishing between patients with sepsis, severe sepsis and septic shock.

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Section: Resultsmentioning

confidence: 99%

Section: High Level Blood Lactate Demonstrated a Sufficient Prognosti...mentioning

confidence: 99%

Section: Blood Lactate Levels Failed To Distinguish Sepsis Severe Sep...mentioning

confidence: 99%

See 1 more Smart Citation

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

Zhu,

Zhou,

Qin

et al. 2024

Biomedicines

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“…Previous studies mainly focused on the T3 level and did not establish a negative relation between serum FT4 level and mortality ( 11 – 16 ). In a retrospective study, FT4 levels were found associated with 28-day mortality in patients with sepsis; however, no further analysis regarding the prognostic value of FT4 was performed ( 17 ). Despite all factors related, our result showed a clear prognostic power of the FT4 level on 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Association between serum-free thyroxine level and all-cause mortality in critically ill patients: a retrospective study from MIMIC-IV

Dai

et al. 2023

Front. Endocrinol.

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BackgroundLow thyroxine (T4) levels have been observed in critically ill patients; however, controversial results regarding T4 supplemental therapy are reported. The association between serum free T4 (FT4) levels and mortality in critically ill patients has not been fully established and needs to be clarified.MethodsData from the Medical Information Mart for Intensive Care (MIMIC)-IV were collected and analyzed. The association between FT4 level and 30-day mortality after ICU admission was analyzed using Kaplan–Meier curves, spline smoothing fitting, martingale residuals of the null Cox model, and restricted cubic spline (RCS). Logistic regression, Cox regression, and receiver operating characteristic curve (ROC) were used to uncover the relationship and predictive value of serum FT4 and 30-day mortality in critically ill patients.ResultsIn the final analysis, 888 patients were enrolled, and the serum FT4 levels were divided into four groups. A significant difference in 30-day mortality was observed between the four groups. Kaplan–Meier curves also presented significantly higher 30-day mortality in groups 1 and 2 (p < 0.0001). Further multivariance logistic regression showed that group 1 with FT4 levels lower than 0.7 μg/dl can predict 30-day mortality (odds ratio (OR) = 3.30, 95% confidence interval (CI) = 1.04–11.31). Spline smoothing fitting analysis showed a “V”-shaped line between 30-day mortality and FT4 level within 0–3 μg/dl. Further RCS analysis showed that the risk of death decreased rapidly as FT4 levels increased when serum FT4 levels were lower than 1.2 μg/dl and started to become flat afterward. The area under the ROC of the lower FT4 level to predict 30-day mortality was 0.833 (95% CI = 0.788–0.878). Both multivariant Cox regression and logistic regression showed that FT4 levels lower than 1.2 μg/dl can independently predict 30-day mortality when adjusted for other potential confounders (HR = 0.34, 95% CI = 0.14–0.82; OR = 0.21, 95% CI = 0.06–0.79, respectively), but its predictive power disappeared when adjusted for T3 or total T4.ConclusionSerum FT4 levels were significantly negatively associated with 30-day mortality when they were lower than 1.2 μg/dl and could predict the risk of 30-day mortality. A higher FT4 level is potentially related to increased 30-day mortality.

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“…CaMK-IV also is a direct PINK1 kinase and regulator of Parkin expression to control mitophagy [136]. Also, stress response during the early stages of sepsis promotes massive hormone secretion [137][138][139][140], which to some extent affects mitochondrial function. Thyroid hormones can increase mitochondrial biosynthesis [141,142] and regulate mitochondrial autophagy [143].…”

Section: Factors Affecting Mitochondrial Function In Sepsismentioning

confidence: 99%

Metabolic reprogramming consequences of sepsis: adaptations and contradictions

Liu

Zhou

Wang

et al. 2022

Cell. Mol. Life Sci.

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During sepsis, the importance of alterations in cell metabolism is underappreciated. The cellular metabolism, which has a variable metabolic profile in different cells and disease stages, is largely responsible for the immune imbalance and organ failure associated with sepsis. Metabolic reprogramming, in which glycolysis replaces OXPHOS as the main energy-producing pathway, is both a requirement for immune cell activation and a cause of immunosuppression. Meanwhile, the metabolites produced by OXPHOS and glycolysis can act as signaling molecules to control the immune response during sepsis. Sepsisinduced "energy shortage" leads to stagnated cell function and even organ dysfunction. Metabolic reprogramming can alleviate the energy crisis to some extent, enhance host tolerance to maintain cell survival functions, and ultimately increase the adaptation of cells during sepsis. However, a switch from glycolysis to OXPHOS is essential for restoring cell function. This review summarized the crosstalk between metabolic reprogramming and immune cell activity as well as organ function during sepsis, discussed the benefits and drawbacks of metabolic reprogramming to show the contradictions of metabolic reprogramming during sepsis, and assessed the feasibility of treating sepsis through targeted metabolism. Using metabolic reprogramming to achieve metabolic homeostasis could be a viable therapy option for sepsis.

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Thyroid hormone disorders: a predictor of mortality in patients with septic shock defined by Sepsis-3?

Cited by 7 publications

References 26 publications

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

Association between serum-free thyroxine level and all-cause mortality in critically ill patients: a retrospective study from MIMIC-IV

Metabolic reprogramming consequences of sepsis: adaptations and contradictions

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