北京大学学报（医学版）2024，Vol.56Issue(3)：526-532,7.DOI:10.19723/j.issn.1671-167X.2024.03.021
脓毒症患者发生正常甲状腺性病态综合征的相关因素
Related factors of euthyroid sick syndrome in patients with sepsis
摘要
Abstract
Objective:To evaluate the prevalence of euthyroid sick syndrome(ESS)in sepsis patients and to explore its influencing factors.Methods:In the study,365 patients diagnosed with sepsis in the emergency critical care department of Shanghai First People's Hospital from January 2017 to January 2023 were retrospectively enrolled.The patients were divided into ESS and non-ESS groups based on whether the patients were complicated with ESS.Baseline variables and relevant clinical data of the enrolled pa-tients were collected.The prevalence of ESS in sepsis patients and its influencing factors were evaluated by multivariate Logistic regression analysis,and the 30-day survival rates were compared between the two groups.The optimal cutoff value for free triiodothyronine(FT3)was explored to predict death in the pa-tients with sepsis.Results:There were 103 sepsis patients with ESS,accounting for 28.2％of the total cases.The severity of sepsis in ESS group was significantly higher than that in non-ESS group(P＜0.05).The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score of ESS group were significantly higher than those of non-ESS group(P＜0.05).C-reactive protein(CRP),procalcitonin(PCT),serum amyloid A(SAA)and interleu-kin-6(IL-6)in ESS group were higher than those in non-ESS group.total cholesterol(TC)and high-den-sity liptein cholesterol(HDL-C)in ESS group were lower than those in non-ESS group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that PCT,IL-6,CRP,SAA and activated partial thromboplatin time(APTT)were independent risk factors for ESS in the sepsis patients(OR values were 1.105,1.006,1.005,1.009 and 1.033,respectively;95％CI were 1.044-1.170,1.001-1.012,1.001-1.009,1.005-1.014,1.004-1.062,respec-tively,P＜0.05).The 30-day survival rate in ESS group was significantly lower than that in non-ESS group,the Long-rank chi-square test value was 16.611,and the difference was statistically significant(P＜0.05).The receiver operation characteristic area under the curve(AUCROC)of FT3 predicted death in the patients with sepsis was 0.924(95％CI 0.894-0.954).The serum FT3 cutoff point was 3.705 pmol/L,the specificity was 0.868,and the sensitivity was 0.950.Conclusion:In this study,the inci-dence of ESS in sepsis patients was determined to be 28.2％with poor prognosis.The results showed that PCT,IL-6,CRP,SAA and APTT were independent risk factors for ESS in sepsis patients,while HDL-C was a protective factor(P＜0.05).FT3 is a novel potential biomarker for predicting death in patients with sepsis.关键词
正常甲状腺性病态综合征/脓毒症/患病率/影响因素/预后Key words
Euthyroid sick syndrome(ESS)/Sepsis/Prevalence/Influencing factors/Prognosis分类
医药卫生引用本文复制引用
曾媛媛,谢云,陈道南,王瑞兰..脓毒症患者发生正常甲状腺性病态综合征的相关因素[J].北京大学学报（医学版）,2024,56(3):526-532,7.基金项目
国家自然科学基金(82202423)和国家临床重点专科项目(Z155080000004)Supported by the National Natural Science Foundation of China(82202423)and Supported by the Special Fund of the National Clinical Key Specialty Construction Program,P.R.China(Z155080000004) （82202423）
