Geanina Popoveniuc1, Tanu Chandra2, Anchal Sud3, Meeta Sharma3, Marc R Blackman4, Kenneth D Burman3, Mihriye Mete5, Sameer Desale5, Leonard Wartofsky3. 1. Division of Endocrinology, Department of Medicine, MedStar Washington Hospital Center, Washington DC Division of Endocrinology, Department of Medicine, Georgetown University Hospital, Washington DC. 2. Division of Endocrinology, Department of Medicine, Veterans Affairs Medical Center, Washington DC Division of Endocrinology, Department of Medicine, George Washington University Hospital, Washington, DC. 3. Division of Endocrinology, Department of Medicine, MedStar Washington Hospital Center, Washington DC. 4. Division of Endocrinology, Department of Medicine, Georgetown University Hospital, Washington DC Division of Endocrinology, Department of Medicine, George Washington University Hospital, Washington, DC Research Service (151), Veterans Affairs Medical Center, Washington DC. 5. Department of Biostatistics and Bioinformatics, Medstar Health Research Institute, Hyattsville, Maryland Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC.
Abstract
OBJECTIVE: To develop diagnostic criteria for myxedema coma (MC), a decompensated state of extreme hypothyroidism with a high mortality rate if untreated, in order to facilitate its early recognition and treatment. METHODS: The frequencies of characteristics associated with MC were assessed retrospectively in patients from our institutions in order to derive a semiquantitative diagnostic point scale that was further applied on selected patients whose data were retrieved from the literature. Logistic regression analysis was used to test the predictive power of the score. Receiver operating characteristic (ROC) curve analysis was performed to test the discriminative power of the score. RESULTS: Of the 21 patients examined, 7 were reclassified as not having MC (non-MC), and they were used as controls. The scoring system included a composite of alterations of thermoregulatory, central nervous, cardiovascular, gastrointestinal, and metabolic systems, and presence or absence of a precipitating event. All 14 of our MC patients had a score of ≥60, whereas 6 of 7 non-MC patients had scores of 25 to 50. A total of 16 of 22 MC patients whose data were retrieved from the literature had a score ≥60, and 6 of 22 of these patients scored between 45 and 55. The odds ratio per each score unit increase as a continuum was 1.09 (95% confidence interval [CI], 1.01 to 1.16; P = .019); a score of 60 identified coma, with an odds ratio of 1.22. The area under the ROC curve was 0.88 (95% CI, 0.65 to 1.00), and the score of 60 had 100% sensitivity and 85.71% specificity. CONCLUSION: A score ≥60 in the proposed scoring system is potentially diagnostic for MC, whereas scores between 45 and 59 could classify patients at risk for MC.
OBJECTIVE: To develop diagnostic criteria for myxedema coma (MC), a decompensated state of extreme hypothyroidism with a high mortality rate if untreated, in order to facilitate its early recognition and treatment. METHODS: The frequencies of characteristics associated with MC were assessed retrospectively in patients from our institutions in order to derive a semiquantitative diagnostic point scale that was further applied on selected patients whose data were retrieved from the literature. Logistic regression analysis was used to test the predictive power of the score. Receiver operating characteristic (ROC) curve analysis was performed to test the discriminative power of the score. RESULTS: Of the 21 patients examined, 7 were reclassified as not having MC (non-MC), and they were used as controls. The scoring system included a composite of alterations of thermoregulatory, central nervous, cardiovascular, gastrointestinal, and metabolic systems, and presence or absence of a precipitating event. All 14 of our MCpatients had a score of ≥60, whereas 6 of 7 non-MCpatients had scores of 25 to 50. A total of 16 of 22 MCpatients whose data were retrieved from the literature had a score ≥60, and 6 of 22 of these patients scored between 45 and 55. The odds ratio per each score unit increase as a continuum was 1.09 (95% confidence interval [CI], 1.01 to 1.16; P = .019); a score of 60 identified coma, with an odds ratio of 1.22. The area under the ROC curve was 0.88 (95% CI, 0.65 to 1.00), and the score of 60 had 100% sensitivity and 85.71% specificity. CONCLUSION: A score ≥60 in the proposed scoring system is potentially diagnostic for MC, whereas scores between 45 and 59 could classify patients at risk for MC.
Authors: Apostolos Chatzitomaris; Rudolf Hoermann; John E Midgley; Steffen Hering; Aline Urban; Barbara Dietrich; Assjana Abood; Harald H Klein; Johannes W Dietrich Journal: Front Endocrinol (Lausanne) Date: 2017-07-20 Impact factor: 5.555