Impact of Thyroid Hormone Levels on Functional Outcome in Neurological and Neurosurgical Early Rehabilitation Patients

Boltzmann, Melanie; Schmidt, Simone; Rollnik, Jens D.

doi:10.1155/2017/4719279

Cited by 9 publications

(11 citation statements)

References 36 publications

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“…While TSH proved to be a relevant outcome predictor in univariate and multivariate analyses in the present study, the fT3 level was not found to be an independent predictor of outcome. This finding contrasts with a previous study investigating thyroid hormone levels in a sample of early neurological rehabilitation patients [ 35 ]. Here, decreased total T3 levels independently predicted an unfavorable functional outcome at the end of early rehabilitative treatment.…”

Section: Discussioncontrasting

confidence: 99%

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

Boltzmann

Schmidt

Rollnik

2022

BioMed Research International

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The present study was aimed at examining thyroid hormones and other clinical factors to improve the accuracy of outcome prediction among critically ill patients undergoing early neurological rehabilitation. Patients consecutively admitted to an intensive or intermediate care unit were screened for eligibility. Serum levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were collected during the first three days after admission. The Glasgow Outcome Scale (GOS) was defined as the primary outcome measure. Thyroid hormone levels and other clinical factors were entered into a binary logistic regression model to predict a good outcome at the end of early rehabilitative treatment. 395 patients (268 males) with a median age of 62 years ( IQR = 52 − 76 ) and a median disease duration of 19 days ( IQR = 13 − 28 ) were included in the study. Most patients (80%) had decreased fT3 values. Patients with low fT3 were admitted earlier to the rehabilitation facility and had more severe impairment upon admission compared to patients with fT3 values within the normal range. Both decreased fT3 and TSH levels were associated with an unfavorable outcome ( GOS ≤ 3 ), but only TSH proved to be an independent predictor in multivariate analyses ( OR = 1.11 ; 95 % CI = 1.02 − 1.22 ). These data suggest that decreased fT3 and TSH levels upon admission may predict an unfavorable outcome at the end of early rehabilitative treatment. Thus, thyroid hormone levels are not only important during acute treatment but also in prolonged critical illness.

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Section: Discussioncontrasting

confidence: 99%

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

Boltzmann

Schmidt

Rollnik

2022

BioMed Research International

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“…In neurological rehabilitation outcome studies, age is an important and independent prognostic factor (e.g., in stroke [ 33 ]). For phase B treatment, age has been shown to predict both functional status at discharge [ 23 , 34 ] and discharge disposition [ 23 ]. In contrast to previous studies, the cause of brain damage was not related to outcome.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, however, functional status will be investigated because it is an important outcome measure in neurological early rehabilitation. The functional status at the end of early rehabilitation, measured with the Early Rehabilitation Barthel Index (ERBI), has been shown to be associated with functional status upon admission, CRS-R score upon admission, age, and time since injury [ 23 , 24 ]. The objective of the present study is to identify the influence of different clinical variables collected during the first four weeks on the functional status at the end of rehabilitative treatment.…”

Section: Introductionmentioning

confidence: 99%

The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation

et al. 2021

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Background The aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment. Methods Patients consecutively admitted to intensive or intermediate care units of a neurological rehabilitation center were enrolled in the study. Consciousness and functional status were assessed with the Coma Recovery Scale-Revised (CRS-R) and the Early Rehabilitation Barthel Index (ERBI), respectively. Both assessments were carried out weekly within the first month and at the end of early rehabilitation. Patient and clinical data were entered into a binary logistic regression model to predict functional status at discharge. Results 327 patients (112 females, 215 males) with a median age of 63 years (IQR = 53–75) and a median disease duration of 18 days (IQR = 12–28) were included. Most patients suffered from stroke (59 %), followed by traumatic brain injury (31 %), and hypoxic ischemic encephalopathy (10 %). Upon admission, 12 % were diagnosed as comatose, 31 % as unresponsive wakefulness syndrome (UWS), 35 % as minimally conscious state (MCS) and 22 % already emerged from MCS (eMCS). Of all patients undergoing complete early rehabilitative treatment (n = 180), 72 % showed improvements in level of consciousness (LOC). In this group, age, initial CRS-R score and gains in CRS-R score after four weeks independently predicted functional outcome at discharge. Conclusions The study confirms the relevance of the CRS-R score for functional outcome prediction. High CRS-R scores and young age facilitate functional improvements and increase the probability to continue treatment in subsequent rehabilitation phases. Moreover, results indicate that recovery might occur over a period of time that extends beyond acute care.

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“…Moreover, studies suggests that thyroid status may influence recovery, prognosis, and outcomes of rehabilitation in stroke patients, but published data provide partially inconsistent results [8][9][10][11][12]. Therefore, the complex interrelationships between the thyroid, the heart and the brain remain an area of interest with a potential for future prevention and treatment approaches.…”

Section: Introductionmentioning

confidence: 99%

Thyroid Function in Patients with Acute Ischemic Stroke

Broczek

2021

JETR

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Stroke is one of the major manifestations of cardiovascular diseases and a leading cause of long-term disability in older adults. Thyroid disfunction, as the most common endocrine disorder, may influence stroke risk and prognosis in multiple and complex ways. The aim of the study was to assess thyroid function in patients hospitalized with acute ischemic stroke. Thyroid hormone profile was evaluated in 50 consecutive patients hospitalized with ischemic stroke. A majority of patients had normal values of TSH, fT3 and fT4, but in 8 (16%) patients, the serum level of thyroid hormones was out of the reference range indicating the need for further assessment. Stroke, as an acute and often severe disease, requires multidisciplinary care and thyroid function assessment may be helpful in the overall plan of treatment.

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Impact of Thyroid Hormone Levels on Functional Outcome in Neurological and Neurosurgical Early Rehabilitation Patients

Cited by 9 publications

References 36 publications

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation

Thyroid Function in Patients with Acute Ischemic Stroke

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