Usefulness of serum thyroid-stimulation hormone (TSH) as a prognostic indicator for acute-on-chronic liver failure.

Abstract

UNLABELLED:

BACKGROUND AND RATIONALE FOR THE STUDY: To investigate thyroid function in patients with acute-on-chronic liver failure (ACLF) caused by hepatitis B virus infection and to determine whether thyroid hormone levels can be used as prognostic markers for assessing severity and prognosis of ACLF patients. We enrolled 75 patients with ACLF and70 patients with chronic hepatitis B (CHB). Continual serum samples were collected during hospitalization from the ACLF patients. The serum thyroid hormone levels (triiodothyronine [T3], thyroxine [T4], free (F)-T3, FT4, and thyroid stimulation hormone [TSH]) were measured by chemiluminescence. The Model for End-stage Liver Disease (MELD) score was used to assess severity.

RESULTS:

ACLF patients showed significantly (p < 0.001) lower values of serum T3, T4, FT3/FT4 and TSH than CHB patients. The T3, T4, and TSH levels in ACLF patients were negatively correlated with the MELD score (T3: r = -0.495, p < 0.001; T4: r = -0.281, p < 0.001; TSH: r = -0.498, p < 0.001), suggesting that serum thyroid hormone levels reflect disease severity. At 1 year, 31 patients died. The T3 (p = 0.016), T4 (p = 0.008), and TSH (p = 0.003) levels in non-survivors were significantly lower than in survivors. The serum TSH level was a significant factor for predicting mortality in ACLF patients (optimal cutoff value = 0.38 IU/mL). The cumulative survival rate was decreased significantly when the serum TSH level was < 0.38 IU/mL (39.2%, p < 0.001).

CONCLUSION:

Serum TSH level may be a useful indicator for assessing severity and prognosis in ACLF patients.

• Authors: Yichen Wu, Shaoli You, Hong Zang, Hongling Liu, Yuanli Mao, Panyong Mao, Bing Zhu, Jun Xu, Guoming Xie, Jingxia Guo, Dongze Li, Shaojie Xin, Zhihong Wan
• Journal: Annals of hepatology (Ann Hepatol) 2015 Mar-Apr Vol. 14 Issue 2 Pg. 218-24 ISSN: 1665-2681 [Print] Mexico
• PMID: 25671831 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Triiodothyronine
• Thyrotropin
• Thyroxine

Topics

• Acute-On-Chronic Liver Failure (blood, diagnosis, mortality, virology)
• Adult
• Area Under Curve
• Biomarkers (blood)
• Female
• Health Status
• Health Status Indicators
• Hepatitis B (complications)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• ROC Curve
• Severity of Illness Index
• Thyrotropin (blood)
• Thyroxine (blood)
• Triiodothyronine (blood)