Supervisors info:
Ροβίνα Νικολέττα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μπακάκος Πέτρος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλειάδης Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: COVID-19 is an infectious disease that causes severe respiratory disease. During its acute phase, patients experience a condition known as Low T3 Syndrome (LT3S). Previous studies have shown that thyroid hormone levels are associated with the severity and prognosis of the disease. The aim of this study was to demonstrate that the presence of LT3S in patients with Sars-Cov 2 infection during their hospitalization in the Intensive Care Unit (ICU) is associated with the intensity of the inflammatory reaction and the course of disease.
Materials and Methods: In order to elaborate this study, 105 patients over the age of 18 years were enrolled, who were laboratory-confirmed (RT-PCR) with COVID-19 disease and were hospitalized in the Intensive Care Unit of the First University Clinic of the General Hospital of Athens "SOTIRIA".The study was based on the retrospective recording of laboratory values and clinical information present in the electronic patient record, and the collection of the material began in January 2021 and was completed in October 2021.Low-T3 syndrome (LT3S) was defined as the serum measurement of FT3 to be <2.3 pg /ml with low or normal TSH levels. Patients were divided into two groups according to serum FT3 values: group with low-T3 syndrome (LT3S) and group without low-T3 syndrome(LT3S).The outcome was defined as the exit from the ICU or the death of the patient, while the time of hospitalization in the ICU, the time of hospitalization in the hospital, the time that the patient remained intubated and whether non-invasive mechanical ventilation was used, was also recorded.
Results: Patients in the LT3S group were older than those who did not have LT3S (median [IQR], 62 [13.7] versus 52.8 [15.5], p=0.011). A trend towards higher mortality rate was observed in the LT3S group but with no statistical significance (32.6% vs. 17.7%, p=0.080). Also, LT3S was not associated with high risk of intubation (HR=1.32, 95%CI:0.78-2.22). In contrast, never smokers with LT3S had 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: Critically ill patients with Sars-Cov 2 infection and LT3S who are hospitalized in the ICU and have never been smokers, have a higher risk of intubation and mortality rate. It is possible, therefore, that LT3S is a prognostic indicator of the severity and poor outcome of critically ill patients with Sars-Cov 2 infection and more specifically in the subgroup of never-smokers.
Keywords:
Low T3 syndrome, COVID-19 infection, Critically ill, Intensive care unit
