Τίτλος:
The Association of TSH and Thyroid Hormones with Lymphopenia in Bacterial Sepsis and COVID-19
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Context: Lymphopenia is a key feature of immune dysfunction in patients with bacterial sepsis and coronavirus disease 2019 (COVID-19) and is associated with poor clinical outcomes, but the cause is largely unknown. Severely ill patients may present with thyroid function abnormalities, so-called nonthyroidal illness syndrome, and several studies have linked thyrotropin (thyroid stimulating hormone, TSH) and the thyroid hormones thyroxine (T4) and 3,5,3′-triiodothyronine (T3) to homeostatic regulation and function of lymphocyte populations. Objective: This work aimed to test the hypothesis that abnormal thyroid function correlates with lymphopenia in patients with severe infections. Methods: A retrospective analysis of absolute lymphocyte counts, circulating TSH, T4, free T4 (FT4), T3, albumin, and inflammatory biomarkers was performed in 2 independent hospitalized study populations: bacterial sepsis (n=224) and COVID-19 patients (n=161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts. Results: Only T3 significantly correlated (ρ=0.252) with lymphocyte counts in patients with bacterial sepsis, and lower concentrations were found in severe lymphopenic compared to nonlymphopenic patients (n=56 per group). Severe lymphopenic COVID-19 patients (n=17) showed significantly lower plasma concentrations of TSH, T4, FT4, and T3 compared to patients without lymphopenia (n=18), and demonstrated significantly increased values of the inflammatory markers interleukin-6, C-reactive protein, and ferritin. Remarkably, after 1 week of follow-up, the majority (12 of 15) of COVID-19 patients showed quantitative recovery of their lymphocyte numbers, whereas TSH and thyroid hormones remained mainly disturbed. Conclusion: Abnormal thyroid function correlates with lymphopenia in patients with severe infections, like bacterial sepsis and COVID-19, but future studies need to establish whether a causal relationship is involved. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Συγγραφείς:
Grondman, I.
De Nooijer, A.H.
Antonakos, N.
Janssen, N.A.F.
Mouktaroudi, M.
Leventogiannis, K.
Medici, M.
Smit, J.W.A.
Van Herwaarden, A.E.
Joosten, L.A.B.
Van De Veerdonk, F.L.
Pickkers, P.
Kox, M.
Jaeger, M.
Netea, M.G.
Giamarellos-Bourboulis, E.J.
Netea-Maier, R.T.
Περιοδικό:
JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM
Εκδότης:
Endocrine Society
Λέξεις-κλειδιά:
albumin; C reactive protein; ferritin; interleukin 6; liothyronine; thyroid hormone; thyrotropin; thyroxine; thyroid hormone; thyrotropin, adult; aged; Article; cohort analysis; coronavirus disease 2019; correlation analysis; disease association; disease severity; electrochemiluminescence immunoassay; female; follow up; Greece; homeostasis; hospital patient; human; immunopathology; lymphocyte count; lymphocyte function; lymphocytopenia; major clinical study; male; nonthyroidal illness syndrome; prognosis; quantitative analysis; retrospective study; sepsis; thyroid disease; university hospital; very elderly; blood; clinical trial; complication; euthyroid sick syndrome; immunology; lymphocytopenia; multicenter study; Netherlands; sepsis, Aged; Aged, 80 and over; COVID-19; Euthyroid Sick Syndromes; Female; Greece; Humans; Lymphocyte Count; Lymphopenia; Male; Netherlands; Retrospective Studies; SARS-CoV-2; Sepsis; Thyroid Hormones; Thyrotropin
DOI:
10.1210/clinem/dgab148
