Association Between Nonthyroidal Illness Syndrome and Disseminated Intravascular Coagulation in Sepsis

Abstract

Purpose

Both nonthyroidal illness syndrome (NTIS) and disseminated intravascular coagulation (DIC) are commonly occurred in sepsis. The objective of this study is to evaluate the association between NTIS and DIC, as well as their impacts on the mortality in adults with sepsis.

Patients and methods

A total of 1219 septic patients in two Chinese academic centers from October 2012 and October 2022 were enrolled in analysis. We conduct logistic regression models to analyze the independent risk factors for DIC. Modified Poisson regression models are used to estimate the relative risk (RR) of NTIS on the 28 days mortality in septic patients with DIC. Correlation analysis between thyroid function parameters and coagulation parameters is performed with Pearson coefficient be reported.

Results

DIC is diagnosed on 388 (31.8%) of all the 1219 enrolled septic patients within 72 hours after admission. In multivariate logistic regression models, NTIS (OR 3.19; CI 2.31–4.46; p<0.001) is a statistically significant independent risk factor for DIC after adjustment for potential confounders. Twenty-eight days mortality is significantly higher in DIC patients complicated with NTIS compared with the other DIC patients (23.2% vs 14.0%, p=0.024). This result is also robust in different modified Poisson regression models (Model 1: RR 1.46; CI 1.25–1.70; p<0.001; Model 2: RR 1.35; CI 1.14–1.60; p<0.001; Model 3: RR 1.18; CI 1.02–1.37; p=0.026). Correlation analysis reveals that the thyroid function parameters of FT3, FT4 and TSH only have weak correlations with coagulation parameters of platelet count, fibrinogen, FDP, D-dimers, PT, APTT and INR in sepsis.

Conclusion

NTIS is an independent risk factor for DIC in adults with sepsis. DIC patients complicated with NTIS have significantly higher severity and higher rate of mortality.

Keywords:

• sepsis
• low T3 syndrome
• nonthyroidal illness syndrome
• thyroid function
• disseminated intravascular coagulation

Data Sharing Statement

The data will be shared upon request from the corresponding authors.

Ethics Approval and Consent to Participate

This study was approved by the institutional ethics board of Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Xinhua Hospital, Shanghai Jiaotong University School of Medicine. As a non-interventional retrospective study, informed consent was waived by the Ethical committee of Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Xinhua Hospital, Shanghai Jiaotong University School of Medicine. The study was performed in accordance with the 1964 Helsinki Declaration and its later amendments.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest in this work.

Additional information

Funding

No funds, grants, or other support was received.