ECE2022 Poster Presentations Thyroid (136 abstracts)
Serum FT3 levels and FT3/FT4 ratio as predictors for poor prognosis in hospitalized COVID-19 patients
Marica Milo 1 , Giulia Di Dalmazi 1 , Fabrizio Febo 2 , Sara Coluzzi 2 , Federica Carrieri 1 , Marco Terrenzio 1 , Giovanna Ferrandu 3 , Antonella Spacone 4 , Giorgio Napolitano 1 & Giustino Parruti 5
1University “G.d’Annunzio“ of Chieti-Pescara, Department of Medicine and Aging Sciences, Chieti, Italy; 2Pescara General Hospital, Endocrinology and Metabolism Unit, Pescara, Italy; 3Pescara General Hospital, Internal Medicine Unit, Pescara, Italy; 4Pescara General Hospital, Respiratory Medicine Unit, Pescara, Italy; 5Pescara General Hospital, Infectious Diseases Unit, Pescara, Italy
Background: The coronavirus disease 2019 (COVID-19) can involve multiple organs and systems, including the endocrine system. In particular, thyroid dysfunctions are frequently seen in COVID-19 patients. The aim of this study was to evaluate thyroid function in hospitalized COVID-19 patients and to correlate thyroid function with inflammatory status, blood count parameters and mortality.
Materials and methods: Data of COVID-19 patients admitted to the hospital of Pescara between October 2020 and March 2021 were retrospectively evaluated. Serum thyrotropin (TSH), free thyroxine (FT4), free triiodothyronine (FT3), FT3/FT4 ratio, thyroid antibodies (TgAb, TPOAb), inflammatory and blood count parameters (C-reactive protein, CRP; interleukin-6, IL-6; red blood cell, RBC; white blood cells, WBC; platelets, PLT; neutrophil to lymphocytic ratio, NLR) were analyzed and compared between survivors and non-survivors.
Results: Three hundred thirty-four adult COVID-19 patients were considered for potential enrollment, and after assessment of inclusion and exclusion criteria, 264 were enrolled. The median age was 74.4 (20.6) years, and 167 patients (63.5%) were males. The average hospital stay was 9 days. Of the 264 enrolled patients, 101 (38.2 %) died of COVID-19 complications. The characteristics of survivors and non-survivors are shown in table 1. Serum FT3 levels and FT3/FT4 ratio were significantly lower in non-survivors compared to survivors. Instead, inflammatory and blood count parameters, except for RBC, were significantly higher in survivors. Notably, FT3 levels and FT3/FT4 ratio negatively correlated with CRP and NLR (r=-0.2, P<0.05). In Kaplan-Meier and Cox regression analyses, low FT3 levels (FT3 less than 2.5 pg/ml) were independently associated with mortality (H.R. 1.7, CI 95 % 1.01- 2.96, P=0.042).
| Survivors (N=163) | Non-survivors (N=101) | P value | |
| Age, years | 68.5 (18.8) | 83.5 (12.7) | <0.001 |
| Sex M, N % | 104 (63.8%) | 64 (63%) | ns |
| Hospital stay, days | 10 (8) | 9 (11) | ns |
| TSH (μUI/ml) | 0.7 (0.9) | 0.7 (0.9) | ns |
| FT4 (ng/dl) | 1.1 (0.3) | 1.1 (0.4) | ns |
| FT3 (pg/ml) | 2.5 (0.4) | 2 (0.6) | <0.001 |
| FT3/FT4 ratio | 2.3 (0.9) | 1.9 (0.7) | <0.001 |
| TPOAb (IU/ml) | 0.5 (0.9) | 0.5 (1.2) | ns |
| TgAb (IU/ml) | 0 (0.2) | 0 (0.2) | ns |
| IL-6 (pg/ml) | 38.9 (109.9) | 58 (80.9) | <0.05 |
| CRP (pg/ml) | 45.1 (65.5) | 98.1 (87.9) | <0.001 |
| WBC (*103 /μL) | 6.4 (4.4) | 8.2 (5.6) | <0.001 |
| RBC (*106 /μL) | 4.4 (0.8) | 4.1 (1.0) | <0.001 |
| PLT (*103 /μL) | 165 (123) | 193 (111) | <0.05 |
| NLR: | 5.3 (6.5) | 11.2 (19.8) | <0.001 |
Conclusions: FT3 levels and FT3/FT4 ratio correlate negatively with inflammatory markers and may be predictive for poor prognosis in hospitalized COVID-19 patients.
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