The Clinical Significance of Serum Thyroid Stimulating Hormone in the Prognosis of Adult Patients with Emergency Sepsis
Objective To investigate the clinical significance of serum thyroid stimulating hormone (TSH)in the prognosis of adult patients with emergency sepsis.Methods 150 adult patients with sepsis admitted to the Emergency Department of our hospital from March,2020 to June,2022 were retrospectively included as the subjects.We detected five serum thyroid functions within 24 hours prior to ICU admission using electrochemiluminescence method.Mortality within 28 days after admission was recorded for all patients. Results Serum TSH level in the death group was significantly lower than that in the survival group,while sequential organ failure assessment (SOFA)score,procalcitonin (PCT),creatinine (Cr)and blood urea nitrogen (BUN)levels were all significantly higher than those in the survival group (P<0.05).Spearman rank correlation analysis showed that serum TSH level was significantly negatively correlated with SOFA score and PCT at emergency admission (P<0.05).Multivariate logistic regression analysis showed that serum TSH was an independent predictor of 28-day death in adults with emergency sepsis (P<0.05).The predictive value of serum TSH for 28-day death in patients with emergency sepsis at admission was 0.870 (95％ CI 0.806-0.934),with cut-off value of 2.35mIU/L,specificity of 80.4％,sensitivity of 87.2％,and its predictive performance was better than SOFA score,PCT,Cr and BUN.Kaplan-Meier curve analysis suggested that patients with low serum TSH (<2.35mIU/L)had lower overall survival and shorter median survival than those with high serum TSH (≥2.35mIU/L)(P<0.001).In addition,the inflammatory cytokines interleukin (IL)-1β,IL-6,IL-18,IL-11 and intercellular cell adhesionmolecule-1(ICAM-1)in the death group were all significantly higher than those in the survival group (P<0.05).Spearman rank correlation coefficient analysis indicated that serum TSH was negatively correlated with IL-1β,IL-6,IL-18,IL-11 and ICAM-1 (P<0.05).Conclusion Low serum TSH levels on admission are associated with an increased risk of death in adults with emergency sepsis.Serum TSH has promising value as an early warning marker for a poor short-term prognosis in adults with emergency sepsis.
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