血清促甲状腺激素在成人急诊脓毒症患者预后中的临床意义

The Clinical Significance of Serum Thyroid Stimulating Hormone in the Prognosis of Adult Patients with Emergency Sepsis

目的探讨血清促甲状腺激素(TSH)在成人急诊脓毒症患者预后中的临床意义。方法回顾性连续纳入2020年3月至2022年6月期间我院急诊科收治的150例成人脓毒症患者。通过电化学发光法检测ICU入院前24h内血清甲状腺功能五项。记录所有患者入院后28d内死亡率。结果死亡组血清TSH水平显著低于存活组,序贯器官衰竭评估(SOFA)评分、降钙素原(PCT)、肌酐(Cr)、尿素氮(BUN)水平均显著高于存活组(P<0.05)。经Spearman秩相关分析,急诊入院时血清TSH水平与SOFA评分和PCT均呈显著负相关(P<0.05)。多因素Logistic回归分析表明,血清TSH是成人急诊脓毒症患者28d死亡的独立预测因子(P<0.05)。入院时血清TSH预测急诊脓毒症患者28d死亡的AUC为0.870(95%CI 0.806~0.934),截断值为2.35mIU/L,特异性为80.4%,灵敏度为87.2%,其预测价值优于SOFA评分、PCT、Cr和BUN。Kaplan-Meier曲线分析中,与高血清TSH患者(≥2.35mIU/L)相比,低血清TSH患者(<2.35mIU/L)总生存率更低,中位生存时间更短(P<0.001)。此外,死亡组患者炎症细胞因子白细胞介素(IL)-1β、IL-6、IL-18、IL-11和细胞间黏附分子-1(ICAM-1)均显著高于存活组(P<0.05)。经Spearman秩相关系数分析,血清TSH与IL-1β、IL-6、IL-18、IL-11和ICAM-1均呈负相关(P<0.05)。结论入院时低血清TSH水平与成人急诊脓毒症患者死亡风险增加相关,血清TSH有希望作为成人急诊脓毒症患者短期预后不良的早期预警标志物。

Objective To investigate the clinical significance of serum thyroid stimulating hormone(TSH)in the prognosis of adult patients with emergency sepsis.Methods 150 adult patients with sepsis admitted to the Emergency Department of our hospital from March,2020 to June,2022 were retrospectively included as the subjects.We detected five serum thyroid functions within 24 hours prior to ICU admission using electrochemiluminescence method.Mortality within 28 days after admission was recorded for all patients.Results Serum TSH level in the death group was significantly lower than that in the survival group,while sequential organ failure assessment(SOFA)score,procalcitonin(PCT),creatinine(Cr)and blood urea nitrogen(BUN)levels were all significantly higher than those in the survival group(P<0.05).Spearman rank correlation analysis showed that serum TSH level was significantly negatively correlated with SOFA score and PCT at emergency admission(P<0.05).Multivariate logistic regression analysis showed that serum TSH was an independent predictor of 28-day death in adults with emergency sepsis(P<0.05).The predictive value of serum TSH for 28-day death in patients with emergency sepsis at admission was 0.870(95%CI 0.806-0.934),with cut-off value of 2.35mIU/L,specificity of 80.4%,sensitivity of 87.2%,and its predictive performance was better than SOFA score,PCT,Cr and BUN.Kaplan-Meier curve analysis suggested that patients with low serum TSH(<2.35mIU/L)had lower overall survival and shorter median survival than those with high serum TSH(≥2.35mIU/L)(P<0.001).In addition,the inflammatory cytokines interleukin(IL)-1β,IL-6,IL-18,IL-11 and intercellular cell adhesionmolecule-1(ICAM-1)in the death group were all significantly higher than those in the survival group(P<0.05).Spearman rank correlation coefficient analysis indicated that serum TSH was negatively correlated with IL-1β,IL-6,IL-18,IL-11 and ICAM-1(P<0.05).Conclusion Low serum TSH levels on admission are associated with an increased risk of death in adults with emergency sepsis.Serum TSH has promising value as an early warning marker for a poor short-term prognosis in adults with emergency sepsis.