Predictors for euthyroid sick syndrome and its impact on in-hospital clinical outcomes in high-risk patients undergoing coronary artery bypass grafting

Abstract

Objective: The purpose of this cohort study was to investigate the independent relationship between euthyroid sick syndrome and in-hospital outcomes in high-risk patients undergoing isolated coronary artery bypass grafting, and we also examined the direct correlation between pre- or intra-operative variables and the incidence of coronary artery bypass grafting–associated euthyroid sick syndrome. Methods: The present study enrolled high-risk patients undergoing coronary artery bypass grafting from 1 January 2017 to 31 December 2017 in Beijing Anzhen hospital, including 387 (58.7%) patients with coronary artery bypass grafting–associated euthyroid sick syndrome and 272 (41.3%) patients without coronary artery bypass grafting–associated euthyroid sick syndrome. Results: The mean age of euthyroid sick syndrome group was significantly older than that of no euthyroid sick syndrome group (65.9 ± 7.5 vs 60.9 ± 9.6, p < 0.0001). Compared with the control group, significantly higher proportions of patients with euthyroid sick syndrome had presented with the following clinical characteristics at hospital admission: moderate and poor left ventricular ejection fraction (42.9% vs 28.7%, p < 0.0001), higher euroscore II (9.2 ± 4.1 vs 8.0 ± 3.9, p < 0.0001). Multivariate logistic regression analysis on the total patients revealed that the independent risk factors for coronary artery bypass grafting–associated euthyroid sick syndrome were advanced age (odds ratio = 1.07, 95% confidence interval = 1.05-1.09, p < 0.0001), higher euroscore II (odds ratio = 1.06, 95% confidence interval = 1.01-1.11, p = 0.013), and moderate and poor left ventricular ejection fraction (odds ratio = 2.26, 95% confidence interval = 1.61-3.18, p < 0.0001). Furthermore, euthyroid sick syndrome was independently correlated with an increased risk of in-hospital major adverse cardiovascular and cerebral events (odds ratio = 3.40, 95% confidence interval = 1.64-7.02, p = 0.001) and post-infection (odds ratio = 8.11, 95% confidence interval = 3.97-16.57, p < 0.0001) Besides, we also confirmed coronary artery bypass grafting–associated euthyroid sick syndrome was associated with Sequential Organ Failure Assessment maximum greater than 11 (odds ratio = 2.98, 95% confidence interval = 1.90-4.65, p < 0.0001), which predicted an in-hospital death rate of 95%, independently. Conclusion: Coronary artery bypass grafting–associated euthyroid sick syndrome exerted detrimental effects on short-term clinical outcomes in high-risk patients undergoing isolated coronary artery bypass grafting. Advanced age, higher euroscore II, and moderate and poor left ventricular ejection fraction were independent risk factors for coronary artery bypass grafting–associated euthyroid sick syndrome.

Non-thyroidal illness syndrome predicts outcome in adult critically ill patients: a systematic review and meta-analysis

“…Studies were conducted between 2001 and 2020. There was a high risk of bias ( Table 1 ) resulting from the observational ( 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ) and retrospective study design ( 17 , 18 , 22 , 30 , 31 , 37 ) used in the studies. The absence of statistical control for known confounders ( 17 , 23 , 25 , 26 , 34 , 37 ) and for covariance with severity scores ( 24 , 35 ) was also identified.…”

“…In Table 3 , we present the characteristics of the 25 included studies and the data on the association between serum TH levels and the outcome of critically ill patients. As to types of diseases, 14 studies presented information from patients admitted to ICU with non-specified clinical and surgical critical illness, 4 studies included patients admitted for cardiovascular causes – 2 from patients undergoing CABG ( 19 , 39 ) and 2 from decompensated heart failure ( 17 , 20 ), 3 studies included patients with sepsis ( 24 , 29 , 37 ), 1 study was on patients with polytrauma ( 21 ) and 1 study was from a burning trauma center ( 22 ). Mortality rates varied greatly since they derived from a heterogeneous population with different follow-up periods.…”

Low-normal free triiodothyronine as a predictor of post-operative atrial fibrillation after surgical coronary revascularization

“…Other study monitored the dynamic levels of FT3 and found that decreased tendency in FT3 values was prominent on the postoperative second day, which is the most common day for arrhythmia following cardiac surgery ( 20 ). Interestingly, CABG-related euthyroid sick syndrome exerted detrimental effects on in-hospital adverse cardiovascular outcomes ( 21 ). Recently, off-pump CABG and one-stop hybrid coronary revascularization become the common effective ways of surgical coronary revascularization, which avoid the negative effects of cardiopulmonary bypass.…”

The Impact of Statins before High-Risk CABG on Postoperative Multiple Organ Function

“…erefore, it is essential to develop prognostic models for accurately identify mortality and morbidity after isolated CABG, especially high-risk CABG. Research data proved that the Sequential Organ Failure Assessment (SOFA) score per se as an independent risk factor for mortality after CABG and SOFA could be regarded as the most effective prognostic model for guiding the use of preventive and early therapeutic strategies to reduce mortality and morbidity for patients undergoing high-risk CABG [2,3]. Recently, SOFA maximum is recommended to assess multiorgan dysfunction over time and severe multiorgan failure, measured by SOFA maximum greater than 11, predicted an in-hospital mortality of 95% [3,4].…”