Low T3 Syndrome in severely ill patients with COVID-19 infection
Introduction The coronavirus disease (COVID-19) is an infectious disease, caused by the SARS-CoV-2 virus, which causes severe respiratory disease. Critical ill patients often experience a condition known as Low T3 Syndrome (LT3S). Previous studies showed an association between low FT3 levels and mor...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
European Publishing
2023-10-01
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| Series: | Pneumon |
| Subjects: | |
| Online Access: | http://www.pneumon.org/Low-T3-Syndrome-in-severely-ill-patients-with-COVID-19-infection,168493,0,2.html |
| Summary: | Introduction
The coronavirus disease (COVID-19) is an infectious disease,
caused by the SARS-CoV-2 virus, which causes severe respiratory disease.
Critical ill patients often experience a condition known as Low T3 Syndrome
(LT3S). Previous studies showed an association between low FT3 levels and
mortality among patients with COVID-19. Moreover, thyroid hormones might
be altered by cigarette consumption. Τhe aim of this study was to investigate
the association of LT3S with mortality and the severity and risk of intubation
in critically ill patients with COVID-19 infection, and to explore whether this
association is confounded by smoking.
Methods
A total of 105 critically ill patients aged ≥18 years, with laboratoryconfirmed
(RT-PCR) COVID-19 were enrolled. The study was conducted
between January 2021 and October 2021 in the Intensive Care Unit of the 1st
Department Respiratory Medicine in ‘Sotiria’ Hospital and laboratory data and
clinical information were retrieved retrospectively from the electronic patients
record. LT3S was defined as serum levels of FT3 <2.3 pg/mL with low or
normal TSH levels. Patients were divided into two groups according to serum
FT3 values: group with LT3S and group without LT3S. Mortality in the ICU was
the primary outcome of the study, while the risk of intubation was a secondary
outcome.
Results
In all, 43 out of the 105 included patients were diagnosed with
LT3S. Patients in the LT3S group were older than those with non LT3S [median
(IQR): 62 (13.7) vs 52.8 (15.5), p=0.011]. Non-statistically significantly higher
mortality rate, SOFA and APACHE II scores were observed in the LT3S group
compared to no LT3S group (p=0.080, p=0.311 and p=0.079, respectively).
Moreover, LT3S was not associated with high risk of intubation (HR=1.32; 95%
CI: 0.78–2.22). Twenty-five patients (58.1%) in the LT3S group were never
smokers, versus 41 (66.1%) patients in the non LT3S group. Never smokers
with LT3S had significantly higher mortality rate than never smokers without
LT3S (40% vs 17.1%, p=0.039), and LT3S in the never smoking subgroup was
associated with an increased risk of intubation (HR=2.21; 95% CI: 1.18–4.16).
Conclusions
LT3S was found to be associated with mortality of patients
with critical COVID-19 among never smokers but not among ex-smokers or
active smokers. This finding may denote that smoking may act as a confounder
of the association between LT3S and mortality. Further investigation is needed
to demonstrate the impact of LT3S in critically ill patients with COVID-19
infection, as well as the role of smoking in the development of the syndrome. |
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| ISSN: | 1105-848X 1791-4914 |