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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (3): 526-532. doi: 10.19723/j.issn.1671-167X.2024.03.021

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Related factors of euthyroid sick syndrome in patients with sepsis

Yuanyuan ZENG,Yun XIE,Daonan CHEN,Ruilan WANG*()   

  1. Department of Emergency And Critical Care, Shanghai General Hospital of Nanjing Medical University, Shanghai 201620, China
  • Received:2023-12-05 Online:2024-06-18 Published:2024-06-12
  • Contact: Ruilan WANG E-mail:wangyusun@hotmail.com
  • Supported by:
    the National Natural Science Foundation of China(82202423);the Special Fund of the National Clinical Key Specialty Construction Program, P. R. China(Z155080000004)

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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 patients 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 patients 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 evaluationⅡ(APACHEⅡ)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 interleukin-6 (IL-6) in ESS group were higher than those in non-ESS group. total cholesterol(TC)and high-density 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, respectively, 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 incidence 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.

Key words: Euthyroid sick syndrome (ESS), Sepsis, Prevalence, Influencing factors, Prognosis

CLC Number: 

  • R459.7

Figure 1

Flow chart of patient screening for enrollment"

Table 1

Comparison of general clinical data of patients"

Variable Non-ESS group (n=262) ESS group (n=103) t/χ2 P
Age/years, ${\bar x}$ ± s 66.00±17.21 68.50±17.90 -1.220 0.220
Female, n(%) 112 (42.74) 46 (44.66) 0.110 0.740
BMI/(kg/m2)，${\bar x}$ ± s 23.54±8.28 24.09±10.08 0.408 0.723
History of smoking, n(%) 60 (22.90) 20 (19.41) 0.524 0.699
Hypertension, n(%) 102 (38.90) 33 (32.03) 1.507 0.220
Diabetes, n(%) 91 (34.73) 32 (31.06) 0.444 0.505
Coronary heart disease, n(%) 21 (8.01) 8 (7.76) 0.006 1.000
  Hypohepatia, n(%) 16 (6.10) 5 (4.85) 0.213 0.830
Renal inadequacy，n(%) 39 (14.88) 11 (10.67) 1.100 0.370
Sepsis, n(%) 204 (77.87) 66 (64.07) 7.297 0.007
Septic shock, n(%) 58 (22.13) 37 (35.92)
Infection site, n(%)
  Pulmonary infection 93 (35.49) 36 (34.95) 1.532 0.170
  Intestinal infection 87 (33.20) 28 (27.18)
  Urinary tract 25 (9.54) 12 (11.65)
  Skin subcutaneous tissue 23 (8.77) 10 (9.70)
  Others 34 (12.97) 17 (16.50)
APACHEⅡ, ${\bar x}$ ± s 17.54±9.27 19.86±8.68 2.110 0.035
SOFA, ${\bar x}$ ± s 7.00±4.76 8.37±4.90 2.370 0.018

Table 2

Comparison of patient-related clinical indicators"

Variable Non-ESS group (n=262) ESS group (n=103) t/Z P
CRP/(mg/L), M(P25, P75) 83.9 (29.5，166.9) 115.1 (64.8，235.2) 2.916 0.004
SAA/(mg/L), M(P25, P75) 83.8 (53.9，103.0) 146.9 (86.8，242.4) 5.331 0.000
PCT/(mg/L), M(P25, P75) 2.81 (1.89，8.68) 8.17 (3.24，14.79) 6.508 0.000
IL-6/(ng/L), M(P25, P75) 54.53 (30.13，77.62) 88.17 (40.25，171.00) 2.926 0.003
Lymphocyte count, M(P25, P75) 0.77 (0.42，1.03) 0.77 (0.55，1.48) 1.544 0.123
TC/(mmol/L), ${\bar x}$ ± s 3.17±1.36 2.66±1.05 3.360 0.001
TG/(mmol/L), ${\bar x}$ ± s 1.69±1.24 1.73±1.11 -0.239 0.811
HDL-C/(mmol/L), ${\bar x}$ ± s 1.00±0.08 0.61±0.41 4.950 0.000
LDL-C/(mmol/L), ${\bar x}$ ± s 1.64± 0.97 1.64±1.49 -0.092 0.927
PT/s, ${\bar x}$ ± s 15.51±3.93 16.77±6.15 -1.910 0.057
APTT/s, ${\bar x}$ ± s 35.11±10.19 43.56±16.57 -4.810 0.000
Fibrinogen concentration/(g/L), ${\bar x}$ ± s 2.20±0.91 1.98±0.24 2.090 0.090
Total plasma protein/(g/L), ${\bar x}$ ± s 47.66±17.28 48.77±15.73 -0.584 0.560
Albumin /(g/L), ${\bar x}$ ± s 29.55±5.22 29.56±4.85 -0.031 0.975
Prealbumin/(mg/L), ${\bar x}$ ± s 113.11±57.79 109.61±66.08 0.469 0.640

Table 3

Univariate and multivariate Logistic regression analysis of sepsis with ESS"

VariableUnivariate analysis Multiplicity
OR 95% CI P OR 95% CI P
PCT/(mg/L) 1.110 1.070-1.152 0.000 1.105 1.044-1.170 0.001
IL-6/(ng/L) 1.009 1.005-1.012 0.000 1.006 1.001-1.012 0.030
CRP/(mg/L) 1.003 1.001-1.006 0.015 1.005 1.001-1.009 0.011
SAA/(mg/L) 1.008 1.004-1.011 0.000 1.009 1.005-1.014 0.000
HDL-C/(mmol/L) 0.500 0.336-0.746 0.001 0.442 0.259-0.753 0.003
APTT/s 1.049 1.030-1.068 0.000 1.033 1.004-1.062 0.024

Figure 2

Kaplan-Meier survival curves for ESS and non-ESS groups Log-rank P < 0.01. ESS, euthyroid sick syndrome."

Figure 3

ROC analysis of FT3 in predicting death in patients with sepsis FT3, free triiodothyronine; ROC, receiver operating characteristic."

Table 4

Predictive value of FT3 for death in patients with sepsis"

FT3-cutoff value Sensitivity/% Specificity/% Youden index
3.280 0.917 0.884 0.801
3.320 0.917 0.868 0.785
3.705 0.950 0.868 0.818
4.270 0.975 0.793 0.768
4.485 0.983 0.702 0.685
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