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

Türkay Akbaş
Türkay Akbaş
 et 
Harun Güneş
Harun Güneş
   | 30 janv. 2024
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Article Category: Research Article
Publié en ligne: 30 janv. 2024
Pages: 56 - 63
Reçu: 09 août 2023
Accepté: 13 nov. 2023
DOI: https://doi.org/10.2478/jccm-2024-0002
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© 2024 Türkay Akbaş et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Thyroid hormone results of COPD patients with acute hypercapnic respiratory failure

Parameters N (%)
Normal thyroid hormone levels 29 (36.3)
Non-thyroidal illness syndrome
  Low fT3 17 (21.2)
  Low fT4 14 (17.5)
  Low TSH 4 (5)
  Low fT3 and fT4 8 (10)
  Low TSH and fT3 3 (3.7)
  Low TSH and fT4 4 (5)
  Low TSH, fT3 and fT4 1 (1.3)
Total 80 (100%)

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

Parameters TSH fT4 fT3
≥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, years 70.9 ± 9.6 75.3 ± 8.3 0.119 71.9 ± 8.9 70.7 ± 10.7 0.618 71.5 ± 7.0 71.7 ± 10.3 0.936
Male, n (%) 39 (57.4) 7 (58.3) 0.949 28 (52.8) 18 (66.7) 0.236 31 (60.8) 5 (51.7) 0.431
HT, n (%) 42 (61.8) 8 (66.7) 0.746 35 (66.0) 15 (55.6) 0.360 30 (58.8) 20 (69) 0.368
DM, n (%) 21 (30.9) 2 (16.7) 0.493 18 (34.0) 5 (18.5) 0.195 17 (33.3) 6 (20.7) 0.230
CVD, n (%)† 39 (57.4) 6 (50.0) 0.755 33 (62.3) 12 (44.4) 0.156 31 (60.8) 14 (48.3) 0.278
Long-term O2 use, n (%) 31 (45.6) 9 (75.0) 0.060 28 (52.8) 12 (44.4) 0.637 25 (49.0) 15 (51.7) 0.816
Admission from wards, n (%)‡ 35 (51.5) 7 (58.3) 0.611 26 (49.1) 16 (59.3) 0.480 22 (43.1) 20 (69.0) 0.026
APACHE II 22.7 ± 7.5 23.3 ± 7.3 0.816 23.0 ± 7.2 23.4 ± 8.0 0.632 20.9 ± 7.0 26.1 ± 7.1 0.002
GCS 11.9 ± 3.7 9.0 ± 4.2 0.042 11.6 ± 3.7 11.1 ± 4.3 0.570 11.9 ± 3.7 10.7 ± 4.1 0.184
IMV, n (%) 30 (44.1) 5 (41.7) 0.875 22 (41.5) 13 (48.1) 0.710 19 (37,3) 16 (55.2) 0.120
Vasopressor, n (%) 25 (36.3) 3 (25) 0.912 19 (35.9) 9 (33.3) 0.823 12 (23.5) 16 (55.2) 0.004
Albumin, g/dL 3.3 ± 0.5 3.2 ± 0.6 0.590 3.3 ± 0.5 3.1 ± 0.6 0.209 3.4 ± 0.5 3.0±0.5 0.059
Creatinine, mg/dL 1.4 ± 1.4 1.3 ± 0.7 0.691 1.4 ± 1.1 1.4 ± 1.4 0.660 1.3 ± 1.1 1.5 ± 1.4 0.473
CRP, mg/dL 7.6 (2–13) 7.9 (1.5–18) 0.740 8 (2–17) 10 (1–13) 0.791 5.5 (1–12) 11 (4.6–16) 0.010
WBC ×103/L 14 ± 7.5 13.3 ± 4.8 0.668 13.8 ± 6.7 14.1 ± 8.1 0.887 12.6 ± 5.0 16.2 ± 9.5 0.027
pH 7.26 ± 0.08 7.29 ± 0.07 0.108 7.28 ± 0.05 7.25 ± 0.10 0.085 7.28 ± 0.07 7.25 ± 0.08 0.102
PCO2, mm Hg 66 ± 17.4 62.8 ± 14.9 0.514 65.5 ± 16.4 65.6 ± 18.4 0.996 64 ± 18 68.0 ± 15.0 0.360
HCO3, mEq/L 25.3 ± 5.5 27.1 ± 6.0 0.376 26.2 ± 4.8 24.4 ± 6.7 0.178 25.6 ± 5.0 25.5 ± 6.6 0.920
PaO2/FiO2, mm Hg 215±92 192 ± 93 0.448 205 ± 92 223 ± 93 0.429 224 ± 95 190 ± 84 0.100
ICU LOS, days 6 (4–10.3) 5 (4–9) 0.554 6 (4–10.5) 5 (4–9) 0.561 5 (4–7) 8 (4–20) 0.021
Hospital LOS, days 10 (6–15.3) 11 (6–20.5) 0.765 11 (7.5–15.5) 10 (6–16) 0.415 9 (6–14) 11 (9–23) 0.142
In-hospital mortality, n (%) 19 (27.9) 4 (33.3) 0.206 16 (30.2) 7 (25.9) 0.797 9 (17.6) 14 (48.3) 0.004

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

Parameters Univariate† Multivariate‡
P OR 95% CI P OR 95% CI
fT3 0.001 0.172 0.062–0.473 0.027 0.271 0.085–0.865
IMV 0.001 6.139 2.073–18.175
Albumin <0.001 0.094 0.026–0.344
Creatinine 0.063 1.490 0.979–2.270
CRP 0.041 1.048 1.002–1.097
WBC 0.044 1.072 1.002–1.147
APACHE II <0.001 1.210 1.099–1.334 0.007 1.155 1.041–1.282
GCS 0.043 0.880 0.777–0.996
Vasopressor <0.001 11.848 3.790–37.037 0.013 5.426 0.439–20.468
Admission from the ward 0.056 2.725 0.973–7.632

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

Parameters NTIS (−) (N = 29) NTIS (+) (N = 51) p
Age, years 70.5 ± 7.3 71.2 ± 9.5 0.445
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 II 21.7 ± 7.0 23.4 ± 7.7 0.295
GCS 11.6 ± 3.8 11.4 ± 4.1 0.829
IMV, n (%) 13 (44.8) 22 (43.1) 0.884
Vasopressor, n (%) 8 (27.6) 20 (39.2) 0.294
Albumin, g/dL 3.5 ± 0.5 3.1 ± 0.5 0.011
Creatinine, mg/dL 1.5 ± 1.3 1.3 ± 1.4 0.635
CRP, mg/dL 6.2 (1.6–12) 9.7 (1.9–14.8) 0.519
WBC, ×103/L 11.1 ± 3.2 13.4 ± 7.0 0.044
pH 7.28 ± 0.06 7.26 ± 0.09 0.392
PCO2, mm Hg 64.0 ± 17.1 66.2 ± 17.0 0.545
HCO3, mEq/L 25.5 ± 4.6 25.7 ± 6.1 0.886
PaO2/FiO2, mm Hg 227 ± 97 202 ± 88 0.251
ICU LOS, days 6 (4–10.5) 5 (4–10) 0.693
Hospital LOS, days 12 (7.5–14.5) 10 (6–16) 0.634
In-hospital mortality, n (%) 4 (13.8) 19 (37.3) 0.022
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