游离三碘甲状腺原氨酸评估老年新型冠状病毒感染患者严重程度及预后的价值

Value of free triiodothyronine levels in evaluating the severity and prognosis of elderly patients with coronavirus disease 2019

目的探讨血清游离三碘甲状腺原氨酸(FT_(3))与老年新型冠状病毒感染(COVID-19)患者严重程度及预后的关系。方法收集2022年12月27日至2023年1月18日在无锡市第九人民医院住院的年龄≥65岁的老年COVID-19患者的临床资料。比较非重型组与重型/危重型组患者的实验室检查结果。根据FT_(3)水平分为T1组(FT_(3)<2.51 pmol/L)、T2组(FT_(3)为2.51~2.95 pmol/L)、T_(3)组(FT_(3)>2.95 pmol/L)。两组间比较采用独立样本t检验。采用logistic回归分析患者发生重型/危重型的影响因素,并分析不同FT_(3)水平的老年COVID-19患者发生重型/危重型的风险程度。采用受试者操作特征曲线(ROC曲线)分析FT_(3)对患者进展为重型/危重型的预测价值,Kaplan-Meier生存曲线和log-rank检验分析患者30 d生存情况。结果190例患者中,重型/危重型组患者的FT_(3)水平为(2.54±0.30)pmol/L,低于非重型组的(2.91±0.69)pmol/L,差异有统计学意义(t=-3.42,P=0.001)。血清FT_(3)水平升高是老年COVID-19患者发生重型/危重型的保护因素[比值比(OR)=0.139,95%可信区间(CI)0.034~0.577,P=0.007]。T1组患者66例,T2组61例,T_(3)组63例。在校正性别、年龄、肺部疾病史、心脏疾病史、高血压病史、糖尿病病史、脑梗死病史、白细胞计数、乳酸脱氢酶、D-二聚体、游离甲状腺素和促甲状腺素后,T1组患者和T2组患者发生重型/危重型的风险分别是T_(3)组患者的10.982倍和3.695倍(均P<0.05)。FT_(3)预测老年COVID-19患者发生重型/危重型的ROC曲线下面积为0.731,灵敏度为0.733,特异度为0.659,临界值为2.53 pmol/L,FT_(3)<2.53 pmol/L的患者30 d生存率低于FT_(3)≥2.53 pmol/L的患者,差异有统计学意义(χ^(2)=13.49,P<0.001)。结论血清FT_(3)水平上升是老年COVID-19患者进展为重型/危重型的保护因素,对血清FT_(3)的定量评估可预测老年COVID-19患者严重程度及预后。

Objective To investigate the relationship between serum free triiodothyronine(FT_(3))and the severity and prognosis of elderly patients with coronavirus disease 2019(COVID-19).Methods Clinical data of the elderly patients aged≥65 years old with COVID-19 who were admitted to the Ninth People′s Hospital of Wuxi from December 27,2022 to January 18,2023 were collected.The laboratory examinations of the non-severe and the severe/critical groups were compared.Patients were divided into group T1(FT_(3)<2.51 pmol/L),group T2(FT_(3)=2.51 to 2.95 pmol/L,),and group T_(3)(FT_(3)>2.95 pmol/L)according to the FT_(3) level.Independent sample t test was used for comparison between groups.Logistic regression analysis was performed to evaluate the risk factors for severe/critical disease,and to analyze the risk of severe/critical COVID-19 in elderly patients with different FT_(3) levels.The receiver operator characteristic(ROC)curve was drawn to analyze the predictive value of FT_(3) on the occurrence of severe/critical disease in patients.Kaplan-Meier survival curve and log-rank test were used to analyze the 30-day survival rate of elderly COVID-19 patients.Results Among the 190 patients,the FT_(3) level in the severe/critical group was(2.54±0.30)pmol/L,which was significantly lower than that in the non-severe group((2.91±0.69)pmol/L),and the difference was statistically significant(t=-3.42,P=0.001).Elevated serum FT_(3) level was a protective factor for severe/critical disease in elderly COVID-19 patients(odds ratio(OR)=0.139,95%confidence interval(CI)0.034 to 0.577,P=0.007).There were 66 patients in the T1 group,61 in the T2 group and 63 in the T_(3) group,respectively.After adjusted for sex,age,history of lung diseases,history of cardiac diseases,history of hypertension,history of diabetes mellitus,history of cerebral infarction,white blood cell count,lactate dehydrogenase,D-dimer,free thyroxine and thyrotropin,the risk of developing severe/critical disease in group T1 and group T2 were 10.982 folds and 3.695 folds of that in group T_(3),respectively(both P<0.05).The area under ROC curve of FT_(3) of predicting severe/critical COVID-19 in the elderly patients was 0.731.The sensitivity and specificity were 0.733 and 0.659,respectively.The cut-off value was 2.53 pmol/L.The 30-day survival rate in patients with FT_(3)<2.53 pmol/L was significantly lower than that in patients with FT_(3)≥2.53 pmol/L(χ^(2)=13.49,P<0.001).Conclusions The elevated level of FT_(3) is a protective factor for progression to severe/critical disease in elderly patients with COVID-19.The evaluation of serum FT_(3) could predict the severity and prognosis of elderly COVID-19 patients.