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Lower Free T3 Levels Linked to Poorer Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Hypercapnic Respiratory Failure Cover

Lower Free T3 Levels Linked to Poorer Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Hypercapnic Respiratory Failure

The Journal of Critical Care Medicine
Volume 10 (2024): Issue 1 (January 2024)
By:  and    
Open Access
|Jan 2024
Figures & tables

Figures & Tables

Table 1.

Thyroid hormone results of COPD patients with acute hypercapnic respiratory failure

ParametersN (%)
Normal thyroid hormone levels29 (36.3)
Non-thyroidal illness syndrome
  Low fT317 (21.2)
  Low fT414 (17.5)
  Low TSH4 (5)
  Low fT3 and fT48 (10)
  Low TSH and fT33 (3.7)
  Low TSH and fT44 (5)
  Low TSH, fT3 and fT41 (1.3)
Total80 (100%)

[i] Abbreviations: COPD, chronic obstructive pulmonary disease; fT3, free triiodothyronine; fT4, free thyroxine; N, number; TSH, thyroid-stimulating hormone.

Table 2.

A comparison of acute hypercapnic respiratory failure COPD patients with and without non-thyroidal illness syndrome

ParametersNTIS (−) (N = 29)NTIS (+) (N = 51)p
Age, years70.5 ± 7.371.2 ± 9.50.445
Male, n (%)17 (58.6)29 (56.9)0.878
HT, n (%)18 (62.1)32 (62.7)0.952
DM, n (%)11 (37.9)12 (23.5)0.171
CVD, n (%)†24 (82,8)35 (68.6)0.167
Long-term O2 use, n (%)14 (48.3)26 (51.0)0.816
Admission from wards, n (%)‡12 (41.4)30 (58.8)0.133
APACHE II21.7 ± 7.023.4 ± 7.70.295
GCS11.6 ± 3.811.4 ± 4.10.829
IMV, n (%)13 (44.8)22 (43.1)0.884
Vasopressor, n (%)8 (27.6)20 (39.2)0.294
Albumin, g/dL3.5 ± 0.53.1 ± 0.50.011
Creatinine, mg/dL1.5 ± 1.31.3 ± 1.40.635
CRP, mg/dL6.2 (1.6–12)9.7 (1.9–14.8)0.519
WBC, ×103/L11.1 ± 3.213.4 ± 7.00.044
pH7.28 ± 0.067.26 ± 0.090.392
PCO2, mm Hg64.0 ± 17.166.2 ± 17.00.545
HCO3, mEq/L25.5 ± 4.625.7 ± 6.10.886
PaO2/FiO2, mm Hg227 ± 97202 ± 880.251
ICU LOS, days6 (4–10.5)5 (4–10)0.693
Hospital LOS, days12 (7.5–14.5)10 (6–16)0.634
In-hospital mortality, n (%)4 (13.8)19 (37.3)0.022

† Including heart failure, ischemic heart disease, any arrhythmia, and heart valve diseases.

‡ The remaining patients were admitted to the ICU from the emergency department.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CVD; cardiovascular disease; CRP, C-reactive protein; DM, diabetes mellitus; GCS, Glasgow coma scale; HT, hypertension; IMV, invasive mechanical ventilation; LOS, length of stay; N, number; NTIS, non-thyroidal illness; WBC, white blood cell count.

Table 3.

A comparison of acute hypercapnic respiratory failure COPD patients with and without low thyroid hormone levels

ParametersTSHfT4fT3
≥0.3 IU/mL (N = 68)<0.3 IU/mL (N = 12)P≥0.93 ng/dL (N = 53)<0.93 ng/dL (N = 27)P≥2 pg/mL (N = 51)<2 pg/mL (N = 29)P
Age, years70.9 ± 9.675.3 ± 8.30.11971.9 ± 8.970.7 ± 10.70.61871.5 ± 7.071.7 ± 10.30.936
Male, n (%)39 (57.4)7 (58.3)0.94928 (52.8)18 (66.7)0.23631 (60.8)5 (51.7)0.431
HT, n (%)42 (61.8)8 (66.7)0.74635 (66.0)15 (55.6)0.36030 (58.8)20 (69)0.368
DM, n (%)21 (30.9)2 (16.7)0.49318 (34.0)5 (18.5)0.19517 (33.3)6 (20.7)0.230
CVD, n (%)†39 (57.4)6 (50.0)0.75533 (62.3)12 (44.4)0.15631 (60.8)14 (48.3)0.278
Long-term O2 use, n (%)31 (45.6)9 (75.0)0.06028 (52.8)12 (44.4)0.63725 (49.0)15 (51.7)0.816
Admission from wards, n (%)‡35 (51.5)7 (58.3)0.61126 (49.1)16 (59.3)0.48022 (43.1)20 (69.0)0.026
APACHE II22.7 ± 7.523.3 ± 7.30.81623.0 ± 7.223.4 ± 8.00.63220.9 ± 7.026.1 ± 7.10.002
GCS11.9 ± 3.79.0 ± 4.20.04211.6 ± 3.711.1 ± 4.30.57011.9 ± 3.710.7 ± 4.10.184
IMV, n (%)30 (44.1)5 (41.7)0.87522 (41.5)13 (48.1)0.71019 (37,3)16 (55.2)0.120
Vasopressor, n (%)25 (36.3)3 (25)0.91219 (35.9)9 (33.3)0.82312 (23.5)16 (55.2)0.004
Albumin, g/dL3.3 ± 0.53.2 ± 0.60.5903.3 ± 0.53.1 ± 0.60.2093.4 ± 0.53.0±0.50.059
Creatinine, mg/dL1.4 ± 1.41.3 ± 0.70.6911.4 ± 1.11.4 ± 1.40.6601.3 ± 1.11.5 ± 1.40.473
CRP, mg/dL7.6 (2–13)7.9 (1.5–18)0.7408 (2–17)10 (1–13)0.7915.5 (1–12)11 (4.6–16)0.010
WBC ×103/L14 ± 7.513.3 ± 4.80.66813.8 ± 6.714.1 ± 8.10.88712.6 ± 5.016.2 ± 9.50.027
pH7.26 ± 0.087.29 ± 0.070.1087.28 ± 0.057.25 ± 0.100.0857.28 ± 0.077.25 ± 0.080.102
PCO2, mm Hg66 ± 17.462.8 ± 14.90.51465.5 ± 16.465.6 ± 18.40.99664 ± 1868.0 ± 15.00.360
HCO3, mEq/L25.3 ± 5.527.1 ± 6.00.37626.2 ± 4.824.4 ± 6.70.17825.6 ± 5.025.5 ± 6.60.920
PaO2/FiO2, mm Hg215±92192 ± 930.448205 ± 92223 ± 930.429224 ± 95190 ± 840.100
ICU LOS, days6 (4–10.3)5 (4–9)0.5546 (4–10.5)5 (4–9)0.5615 (4–7)8 (4–20)0.021
Hospital LOS, days10 (6–15.3)11 (6–20.5)0.76511 (7.5–15.5)10 (6–16)0.4159 (6–14)11 (9–23)0.142
In-hospital mortality, n (%)19 (27.9)4 (33.3)0.20616 (30.2)7 (25.9)0.7979 (17.6)14 (48.3)0.004

† Including heart failure, ischemic heart disease, any arrhythmia, and heart valve diseases.

‡ The remaining patients were admitted to the ICU from the emergency department.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CVD, cardiovascular disease; CRP, C-reactive protein; DM, diabetes mellitus; fT3, free triiodothyronine; fT4, free thyroxine; GCS, Glasgow coma scale; HT, hypertension; IMV, invasive mechanical ventilation; LOS, length of stay; N, number; TSH, thyroid-stimulating hormone; WBC, white blood cell count.

Table 4.

Univariate and multivariate logistic regression analyses for estimating in-hospital mortality

ParametersUnivariate†Multivariate‡
POR95% CIPOR95% CI
fT30.0010.1720.062–0.4730.0270.2710.085–0.865
IMV0.0016.1392.073–18.175
Albumin<0.0010.0940.026–0.344
Creatinine0.0631.4900.979–2.270
CRP0.0411.0481.002–1.097
WBC0.0441.0721.002–1.147
APACHE II<0.0011.2101.099–1.3340.0071.1551.041–1.282
GCS0.0430.8800.777–0.996
Vasopressor<0.00111.8483.790–37.0370.0135.4260.439–20.468
Admission from the ward0.0562.7250.973–7.632

† Those variables with p values of less than 0.100 when tested in univariate analysis are listed in the table.

‡ Hosmer-Lemeshow: X2, 2.937; df, 8; p=0.938.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CI, confidence interval; CRP, C-reactive protein; fT3, free triiodothyronine; fT4, free thyroxine; GCS, Glasgow coma scale; IMV, invasive mechanical ventilation; OR, odds ratio; TSH, thyroid-stimulating hormone; WBC, white blood cell count.

DOI: https://doi.org/10.2478/jccm-2024-0002 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Journal RSS Feed
Language: English
Page range: 56 - 63
Submitted on: Aug 9, 2023
Accepted on: Nov 13, 2023
Published on: Jan 30, 2024
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
hypercapnic respiratory failure,
critical illness,
free triiodothyronine,
mortality predictor,
non-thyroidal illness syndrome
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2024 Türkay Akbaş, Harun Güneş, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 10 (2024): Issue 1 (January 2024)
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