Nayan Lamba1, Chunming Liu2, Hasan Zaidi3, M L D Broekman4, Thomas Simjian2, Chen Shi3, Joanne Doucette2, Steven Ren2, Timothy R Smith3, Rania A Mekary5, Adomas Bunevicius6. 1. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: nayan_lamba@hms.harvard.edu. 2. Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA. 3. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Rudolph Magnus Brain Center, University Medical Center Utrecht, Netherlands. 5. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA. 6. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: adomas.bunevicius@lsmuni.lt.
Abstract
BACKGROUND: Low triiodothyronine (T3) syndrome could be a powerful prognostic factor for acute stroke; yet, a prognostic role for low T3 has not been given enough importance in stroke management. This meta-analysis aimed to evaluate whether low T3 among acute stroke patients could be used as a prognostic biomarker for stroke severity, functional outcome, and mortality. METHODS: Studies that investigated low T3 prognostic roles in acute stroke patients were sought from PubMed/Medline, Embase, and Cochrane databases through 11/23/2016. Pooled estimates of baseline stroke severity, mortality, and functional outcomes were assessed from fixed-effect (FE) and random-effects (RE) models. RESULTS: Eighteen studies met the inclusion criteria. Six studies (1,203 patients) provided data for low-T3 and normal-T3 patients and were meta-analyzed. Using the FE model, pooled results revealed low-T3 patients exhibited a significantly higher stroke severity, as assessed by the National Institutes of Health Stroke Scale (NIHSS) score at admission (mean difference = 3.18; 95%CI = 2.74, 3.63; I2 = 61.9%), had 57% higher risk of developing poor functional outcome (RR = 1.57; 95%CI = 1.33,1.8), and had 83% higher odds of mortality (Peto-OR = 1.83; 95%CI = 1.21, 1.99) compared to normal-T3 patients. In a univariate meta-regression analysis, the low-T3 and stroke severity association was reduced in studies with higher smokers% (slope = -0.11; P = 0.02), higher hypertension% (slope = -0.11; P = 0.047), older age (slope = -0.54; P = 0.02), or longer follow-up (slope = -0/17, P < 0.01). RE models yielded similar results. No significant publication bias was observed for either outcome using Begg's and Egger's tests. CONCLUSIONS: Low-T3 syndrome in acute stroke patients is an effective prognostic factor for predicting greater baseline stroke severity, poorer functional outcome, and higher overall mortality risk.
BACKGROUND: Low triiodothyronine (T3) syndrome could be a powerful prognostic factor for acute stroke; yet, a prognostic role for low T3 has not been given enough importance in stroke management. This meta-analysis aimed to evaluate whether low T3 among acute strokepatients could be used as a prognostic biomarker for stroke severity, functional outcome, and mortality. METHODS: Studies that investigated low T3 prognostic roles in acute strokepatients were sought from PubMed/Medline, Embase, and Cochrane databases through 11/23/2016. Pooled estimates of baseline stroke severity, mortality, and functional outcomes were assessed from fixed-effect (FE) and random-effects (RE) models. RESULTS: Eighteen studies met the inclusion criteria. Six studies (1,203 patients) provided data for low-T3 and normal-T3patients and were meta-analyzed. Using the FE model, pooled results revealed low-T3patients exhibited a significantly higher stroke severity, as assessed by the National Institutes of Health Stroke Scale (NIHSS) score at admission (mean difference = 3.18; 95%CI = 2.74, 3.63; I2 = 61.9%), had 57% higher risk of developing poor functional outcome (RR = 1.57; 95%CI = 1.33,1.8), and had 83% higher odds of mortality (Peto-OR = 1.83; 95%CI = 1.21, 1.99) compared to normal-T3patients. In a univariate meta-regression analysis, the low-T3 and stroke severity association was reduced in studies with higher smokers% (slope = -0.11; P = 0.02), higher hypertension% (slope = -0.11; P = 0.047), older age (slope = -0.54; P = 0.02), or longer follow-up (slope = -0/17, P < 0.01). RE models yielded similar results. No significant publication bias was observed for either outcome using Begg's and Egger's tests. CONCLUSIONS:Low-T3 syndrome in acute strokepatients is an effective prognostic factor for predicting greater baseline stroke severity, poorer functional outcome, and higher overall mortality risk.
Authors: Josi Vidart; Paula Jaskulski; Ana Laura Kunzler; Rafael Aguiar Marschner; André Ferreira de Azeredo da Silva; Simone Magagnin Wajner Journal: Endocr Connect Date: 2022-02-09 Impact factor: 3.335
Authors: Carla Daniele Nascimento Pontes; Juliane Lúcia Gomes da Rocha; Janaina Maria Rodrigues Medeiros; Bruno Fernando Barros Dos Santos; Paulo Henrique Monteiro da Silva; Janine Maria Rodrigues Medeiros; Gabriela Góes Costa; Isabella Mesquita Sfair Silva; Daniel Libonati Gomes; Flávia Marques Santos; Rosana Maria Feio Libonati Journal: Rev Bras Ter Intensiva Date: 2022 Apr-Jun