Hypothyroidism in hospitalized elderly patients: a sign of worse prognosis
Autor: | Noelia Sforza, E. Blanc, D. Caruso, Cristina Faingold, Gabriela Brenta, P Fossati, J. Rosenfarb, R. Rujelman, C. Frigerio, Melanie Rosmarin, Tomás Meroño |
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Rok vydání: | 2017 |
Předmět: |
Male
endocrine system medicine.medical_specialty Pediatrics endocrine system diseases Endocrinology Diabetes and Metabolism Critical Illness 030209 endocrinology & metabolism Thyroid Function Tests Thyroid function tests Persones grans 03 medical and health sciences 0302 clinical medicine Endocrinology Hypothyroidism Risk Factors medicine Humans Euthyroid 030212 general & internal medicine Prospective Studies Prospective cohort study Intensive care medicine Subclinical infection Aged Aged 80 and over medicine.diagnostic_test business.industry Mortality rate medicine.disease Prognosis Comorbidity Thyroid diseases Hospitalization Malalties de la tiroide Female Thyroid function Older people business hormones hormone substitutes and hormone antagonists Kidney disease Hipotiroïdisme |
Zdroj: | Journal of endocrinological investigation. 40(12) |
ISSN: | 1720-8386 |
Popis: | Purpose: Overt hypothyroidism has adverse clinical consequences and might worsen prognosis in critically ill elderly patients. However, the difficult interpretation of thyroid function tests (TFT) due to non-thyroidal illness (NTI) has led to discouragement of screening for thyroid dysfunction. Our aim was to determine the prevalence of TFT compatible with hypothyroidism and to study its influence on mortality among hospitalized elderly patients. Methods: In this prospective study we consecutively included all patients ≥60 years admitted by the Internal Medicine Department to the hospital ward (n = 451) of the Cesar Milstein Hospital in Buenos Aires, Argentina. TFT were done on day 1 and 8. Thyroid function categories were defined as overt and subclinical hypothyroidism, overt and subclinical hyperthyroidism, euthyroidism and NTI. Stage of chronic kidney disease (CKD), Adult Comorbidity Evaluation (ACE)-27, and intra-hospital mortality were recorded. The association between mortality and TFT categories was studied by Cox regression. Results: Out of 451 patients (77.0 ± 7.9 years, 54% females) 76% were categorized as NTI, 4% as overt hypothyroid, 10% as subclinical hypothyroid, 1% as subclinical hyperthyroid and 9% as euthyroid. Overt hypothyroid patients showed significantly higher mortality than the rest of the groups (25%, p < 0.05) while ACE-27 was similar among all of them (p = 0.658). In addition, patients within the overt hypothyroid category showed a higher mortality rate than NTI in a model adjusted by Stage 5-CKD, ACE-27, sex and age [HR 3.1 (1.14-8.41), p < 0.026]. Conclusion: Overt hypothyroidism during hospitalization was associated with elevated mortality. Further studies would reveal if TFT alterations compatible with hypothyroidism should be diagnosed/treated in hospitalized elderly patients. |
Databáze: | OpenAIRE |
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