Prognostic value of serum thyroid hormone levels for patients with acute exacerbation of chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CHENG Yang ,  DAI Li , XIA Guoguang , ZHANG Yunjian

Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, Beijing 100035, P. R. China;

Corresponding author：

DAI Li, Email: dailimd@hotmail.com

Keywords：

Chronic obstructive pulmonary disease; Acute exacerbation; Serum thyroid hormone; Pronosis

DOI：

10.7507/1671-6205.201801064

Video：

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ObjectiveTo investigate the association between serum thyroid hormone levels and prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) without thyroid disease, and explore the prognostic value of serum thyroid hormone levels for patients with AECOPD.MethodsThe clinical data of 239 hospitalized cases of AECOPD [149 males, 90 females, aged 42-92 (77.7±8.9) years] from January 2013 to November 2017 were retrospectively analyzed. Serum thyroid hormone levels including total tetraiodothyronin (TT4), total triiodothyronin (TT3), thyroid stimulating hormone (TSH), free tetraiodothyronin (FT4) and free triiodothyronin (FT3) were measured by chemiluminescence immunoassay. All patients were divided into a survival group and a death group according to the prognosis. Serum thyroid hormone levels were compared between two groups. Correlations of serum thyroid hormone levels with the occurrence of death in AECOPD patients were analyzed. The prognostic value of serum thyroid hormone levels for AECOPD patients was explored by receiveroperating characteristic (ROC) curve analysis. And the best cut-off value of serum thyroid hormone level in predicting the risk of death was calculated.ResultsSerum TT4, TT3, FT4 and FT3 levels in the survival group were significantly higher than those in the death group [TT4: (89.35±21.45) nmol/L vs. (76.84±21.33) nmol/L; TT3: (1.05±0.34) nmol/L vs. (0.72±0.19) nmol/L; FT4: (16.17±2.91) pmol/L vs. (14.45±2.85) pmol/L; FT3: (3.06±0.81) pmol/L vs. (2.24±0.72) pmol/L; all P<0.05]. The differences of serum TSH level between two groups were not statistically significant [0.98 (0.54-1.83)vs. 0.57 (0.31-1.84), P>0.05]. Spearman correlation analysis showed that serum TT4, TT3, FT4 and FT3 levels were significant correlated with the occurrence of death (r values were 0.226, 0.417, 0.220, 0.387, respectively, P<0.05). And there was no significant correlation between serum TSH level and the occurrence of death (P>0.05). ROC curve analysis was done between serum thyroid hormone levels (TT4, TT3, TSH, FT4 and FT3) and the occurrence of death in the AECOPD patients. The areas under ROC curve were 0.659, 0.793, 0.588, 0.655 and 0.772, respectively. Serum TT3 was the best indicator for predicting the occurrence of death. When serum TT3 level was 0.85nmol/L, the Youden index was the highest (0.486), with a sensitivity of 70.2%, and a specificity of 78.3%. It was the best cut-offl value of serum TT3 to predict the risk of death in AECOPD patients.ConculsionsSerum thyroid hormone levels are significant associated with the prognostic for AECOPD patients. There is certain value of serum thyroid hormone levels in prognostic evaluation of AECOPD patients.

Citation： CHENG Yang, DAI Li, XIA Guoguang, ZHANG Yunjian. Prognostic value of serum thyroid hormone levels for patients with acute exacerbation of chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(4): 323-326. doi: 10.7507/1671-6205.201801064 Copy

1.	慢性阻塞性肺疾病急性加重 (AECOPD) 诊治专家组. 慢性阻塞性肺疾病急性加重 (AECOPD) 诊治中国专家共识 (2017 年修订版). 国际呼吸杂志, 2017, 37(14): 1041-1057.
2.	Edwards L, Perrin K, Wijesinghe M, et al. The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission. Respirology, 2011, 16(4): 625-629.
3.	Global Initiative for Chronic Obstructive Lung Disease(GOLD): Global Strategy for the Diagnosis, Management and Prevention of Chronic Pulmonary Disease(2017 REPORT). http://www.goldcopd.org.
4.	Hennemann G, Krenning EP. The kinetics of thyroid hormone transporters and their role in non-thyroidal illness and starvation. Best Pract Res Clin Endocrino Metab, 2007, 21(2): 323-338.
5.	Plikat K, Langgartner J, Buettner R,et al. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit. Metabolism, 2007, 56(2): 239-244.
6.	Sahana PK, Ghosh A, Mukhopadhyay P, et al. A study on endocrine changes in patients in intensive care unit[J]. J Indian Med Assoc, 2008, 106(6): 362-364.
7.	Adler SM, Wartofsky L. The nonthyroidal illness syndrome. Endocrinol Metab Clin North Am, 2007, 36(3): 657-672.
8.	高绪文, 李继莲. 甲状腺疾病. 北京: 人民卫生出版社, 1999, 157-158.
9.	俞春娟, 和明丽, 王俊军, 等. 慢性阻塞性肺疾病急性加重期低 T3 综合征及其临床意义. 上海医药, 2014, 35(17): 34-37.
10.	程洋, 戴丽, 夏国光. 慢性阻塞性肺疾病急性加重患者血清甲状腺激素水平变化及临床意义. 中华结核和呼吸杂志, 2016, 39 (12): 939-943.
11.	程洋, 戴丽, 张运剑, 等. 慢性阻塞性肺疾病急性加重期患者血清甲状腺激素水平与疾病严重程度的相关性. 中国医药, 2017, 12(6): 855-857.
12.	周清, 吴琦. 老年 COPD 患者肺功能与血清甲状腺激素的相关性分析. 山东医药, 2012, 52(12): 92-94.
13.	罗洁, 王德明. 非甲状腺疾病综合征对危重症患者的影响. 中国实用医药, 2010, 5(36): 247-248.
14.	吴红花, 高燕明. 老年病与正常甲状腺病态综合征. 中华老年多器官疾病杂志, 2011, 10(6): 570-572.
15.	余松林. 医学统计学. 北京: 人民卫生出版社, 2002, 164-178.

1. 慢性阻塞性肺疾病急性加重 (AECOPD) 诊治专家组. 慢性阻塞性肺疾病急性加重 (AECOPD) 诊治中国专家共识 (2017 年修订版). 国际呼吸杂志, 2017, 37(14): 1041-1057.
2. Edwards L, Perrin K, Wijesinghe M, et al. The value of the CRB65 score to predict mortality in exacerbations of COPD requiring hospital admission. Respirology, 2011, 16(4): 625-629.
3. Global Initiative for Chronic Obstructive Lung Disease(GOLD): Global Strategy for the Diagnosis, Management and Prevention of Chronic Pulmonary Disease(2017 REPORT). http://www.goldcopd.org.
4. Hennemann G, Krenning EP. The kinetics of thyroid hormone transporters and their role in non-thyroidal illness and starvation. Best Pract Res Clin Endocrino Metab, 2007, 21(2): 323-338.
5. Plikat K, Langgartner J, Buettner R,et al. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit. Metabolism, 2007, 56(2): 239-244.
6. Sahana PK, Ghosh A, Mukhopadhyay P, et al. A study on endocrine changes in patients in intensive care unit[J]. J Indian Med Assoc, 2008, 106(6): 362-364.
7. Adler SM, Wartofsky L. The nonthyroidal illness syndrome. Endocrinol Metab Clin North Am, 2007, 36(3): 657-672.
8. 高绪文, 李继莲. 甲状腺疾病. 北京: 人民卫生出版社, 1999, 157-158.
9. 俞春娟, 和明丽, 王俊军, 等. 慢性阻塞性肺疾病急性加重期低 T3 综合征及其临床意义. 上海医药, 2014, 35(17): 34-37.
10. 程洋, 戴丽, 夏国光. 慢性阻塞性肺疾病急性加重患者血清甲状腺激素水平变化及临床意义. 中华结核和呼吸杂志, 2016, 39 (12): 939-943.
11. 程洋, 戴丽, 张运剑, 等. 慢性阻塞性肺疾病急性加重期患者血清甲状腺激素水平与疾病严重程度的相关性. 中国医药, 2017, 12(6): 855-857.
12. 周清, 吴琦. 老年 COPD 患者肺功能与血清甲状腺激素的相关性分析. 山东医药, 2012, 52(12): 92-94.
13. 罗洁, 王德明. 非甲状腺疾病综合征对危重症患者的影响. 中国实用医药, 2010, 5(36): 247-248.
14. 吴红花, 高燕明. 老年病与正常甲状腺病态综合征. 中华老年多器官疾病杂志, 2011, 10(6): 570-572.
15. 余松林. 医学统计学. 北京: 人民卫生出版社, 2002, 164-178.

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Prognostic value of serum thyroid hormone levels for patients with acute exacerbation of chronic obstructive pulmonary disease

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