Fabyan Esberard de Lima Beltrão1,2,3, Daniele Carvalhal de Almeida Beltrão4, Giulia Carvalhal de Almeida Cordeiro5, Fabricia Elizabeth de Lima Beltrão6, Amanda da Silva Brito7, Kamilla Helen Rodrigues Capistrano8, Isis Henriques de Almeida Bastos9, Fabio Hecht10, Carla Hilário da Cunha Daltro11, Antonio Carlos Bianco12, Maria da Conceição Rodrigues Gonçalves13, Helton Estrela Ramos14,15,16. 1. Faculty of Medical Sciences of Paraíba, Department of Medicine, João Pessoa, Paraíba, Brazil. 2. Federal University of Paraíba, Lauro Wanderley University Hospital, João Pessoa, Paraíba, Brazil. 3. Federal University of Paraíba, Post-Graduation Program in Nutritional Sciences, Department of Nutrition, Center for Health Sciences, João Pessoa, Paraíba, Brazil; fesberard@uol.com.br. 4. Faculty of Medical Sciences of Paraíba, Department of Medicine, João Pessoa, Paraíba, Brazil; danicarvalhal@hotmail.com. 5. Federal University of Campina Grande, 154624, Center for Biological and Health Sciences, Campina Grande, PB, Brazil; carvalhalgiulia@gmail.com. 6. Faculty of Medical Sciences of Paraíba, Department of Medicine, João Pessoa, Paraíba, Brazil; fabriciabeltrao@hotmail.com. 7. Federal University of Paraiba, 123204, Lauro Wanderley University Hospital, Joao Pessoa, PB, Brazil; amandasb_@hotmail.com. 8. Federal University of Paraiba, 123204, Department of Nutrition, Joao Pessoa, PB, Brazil; kamillahrc@gmail.com. 9. Federal University of Bahia, 28111, Post-Graduate Program in Medicine and Health, Medical School of Medicine, Salvador, BA, Brazil; isishenriquesab2@gmail.com. 10. Universidade Federal do Rio de Janeiro, Instituto de Biofísica Carlos Chagas Filho, Av. Carlos Chagas Filho, 373, Bloco G - 1o andar - sala: G1-60, CCS - Ilha do Fundão, Rio de Janeiro, Rio de Janeiro, Brazil, 21.941-902; fabio_hecht@hotmail.com. 11. Federal University of Bahia, 28111, Post-Graduate Program in Medicine and Health, Medical School of Medicine, Salvador, BA, Brazil; carlahcdaltro@gmail.com. 12. University of Chicago Pritzker School of Medicine, 12246, Section of Adult Endocrinology, 5841 S Maryland Ave. MC1027, room M267, Chicago, Illinois, United States, 60637-1470; abianco1@uchicago.edu. 13. Federal University of Paraíba, Post-Graduation Program in Nutritional Sciences, Department of Nutrition, Center for Health Sciences, João Pessoa, Paraíba, Brazil; mariadaconceicaorgoncalves@gmail.com. 14. Federal University of Bahia, 28111, Department of Bioregulation, Health and Science Institute, Salvador, BA, Brazil. 15. Federal University of Bahia, 28111, Post-Graduate Program in Medicine and Health, Medical School of Medicine, Salvador, BA, Brazil. 16. Federal University of Bahia, 28111, Post-Graduate Program in Interactive Processes of Organs and Systems, Health & Science Institute, Salvador, BA, Brazil; ramoshelton@gmail.com.
Abstract
INTRODUCTION: Illness severity in patients infected with COVID-19 is variable. METHODS: Here we conducted an observational, longitudinal, and prospective cohort study to investigate serum thyroid hormone levels (TH) in adult COVID-19 patients, admitted between June and August 2020, and to determine whether they reflect the severity or mortality associated with the disease. RESULTS: 245 patients [median age: 62 (49-75) years] were stratified in non-critical (181) and critically ill (64). 58 patients (23.6 %) were admitted to the ICU and 41 (16.7%) died. 16 (6.5%) exhibited isolated low levels of fT3. fT3 levels were lower in critically ill compared to non-critical patients [fT3: 2.82 (2.46- 3.29) vs 3.09 (2.67-3.63) pg/mL, P=0.007]. Serum rT3 was mostly elevated but less so in critically ill compared to non-critical patients [rT3: 0.36 (0.28- 0.56) vs 0.51(0.31-0.67) ng/mL, P=0.001]. The univariate logistic regression revealed correlation between in-hospital mortality and serum fT3 levels (OR: 0.47; 95% CI: 0.29-0.74; P=0.0019), rT3 levels (OR: 0.09; 95% CI: 0.01-0.49; P=0.006) and the product fT3●rT3 (OR: 0.47; 95% CI: 0.28-0.74; P=0.0026). Serum TSH, fT4, and fT3/rT3 values were not significantly associated with mortality and severity of the disease. A serum cutoff level of fT3 (≤ 2.6 pg/mL) and rT3 (≤0.38 ng/mL) were associated with 3.46 and 5.94 OR of mortality, respectively. The Area Under the ROC curve (AUC) for serum fT3 (AUC=0.66), rT3 (AUC=0.64), and the product of serum fT3●rT3 (AUC=0.70). NTIS (fT3 < 2.0 pg/mL) was associated with a 7.05 OR of mortality (95% CI: 1.78-28.3, P=0.005) and the product rT3●fT3 ≤ 1.29 with an 8.08 OR of mortality (95% CI: 3.14-24.2, P<0.0001). CONCLUSION: This prospective study reports data on the largest number of hospitalized moderate-to-severe COVID-19 patients and correlates serum TH levels with illness severity, mortality, and other biomarkers to critical illness. The data revealed the importance of early assessment of thyroid function in hospitalized patients with COVID-19, given the good prognostic value of serum fT3, rT3 and fT3•rT3 product. Further studies are necessary to confirm these observations.
INTRODUCTION: Illness severity in patientsinfected with COVID-19 is variable. METHODS: Here we conducted an observational, longitudinal, and prospective cohort study to investigate serum thyroid hormone levels (TH) in adult COVID-19patients, admitted between June and August 2020, and to determine whether they reflect the severity or mortality associated with the disease. RESULTS: 245 patients [median age: 62 (49-75) years] were stratified in non-critical (181) and critically ill (64). 58 patients (23.6 %) were admitted to the ICU and 41 (16.7%) died. 16 (6.5%) exhibited isolated low levels of fT3. fT3 levels were lower in critically ill compared to non-critical patients [fT3: 2.82 (2.46- 3.29) vs 3.09 (2.67-3.63) pg/mL, P=0.007]. Serum rT3 was mostly elevated but less so in critically ill compared to non-critical patients [rT3: 0.36 (0.28- 0.56) vs 0.51(0.31-0.67) ng/mL, P=0.001]. The univariate logistic regression revealed correlation between in-hospital mortality and serum fT3 levels (OR: 0.47; 95% CI: 0.29-0.74; P=0.0019), rT3 levels (OR: 0.09; 95% CI: 0.01-0.49; P=0.006) and the product fT3●rT3 (OR: 0.47; 95% CI: 0.28-0.74; P=0.0026). Serum TSH, fT4, and fT3/rT3 values were not significantly associated with mortality and severity of the disease. A serum cutoff level of fT3 (≤ 2.6 pg/mL) and rT3 (≤0.38 ng/mL) were associated with 3.46 and 5.94 OR of mortality, respectively. The Area Under the ROC curve (AUC) for serum fT3 (AUC=0.66), rT3 (AUC=0.64), and the product of serum fT3●rT3 (AUC=0.70). NTIS (fT3 < 2.0 pg/mL) was associated with a 7.05 OR of mortality (95% CI: 1.78-28.3, P=0.005) and the product rT3●fT3 ≤ 1.29 with an 8.08 OR of mortality (95% CI: 3.14-24.2, P<0.0001). CONCLUSION: This prospective study reports data on the largest number of hospitalized moderate-to-severe COVID-19patients and correlates serum TH levels with illness severity, mortality, and other biomarkers to critical illness. The data revealed the importance of early assessment of thyroid function in hospitalized patients with COVID-19, given the good prognostic value of serum fT3, rT3 and fT3•rT3 product. Further studies are necessary to confirm these observations.
Authors: Fabyan Esberard de Lima Beltrão; Daniele Carvalhal de Almeida Beltrão; Giulia Carvalhal; Fabyo Napoleão de Lima Beltrão; Igor Motta de Aquino; Thaíse da Silva Brito; Barbara Costa Paulino; Elisa Aires; Diana Viegas; Fabio Hecht; Bruno Halpern; Liana Clebia De Morais Pordeus; Maria da Conceição Rodrigues Gonçalves; Helton Estrela Ramos Journal: Endocr Connect Date: 2022-09-26 Impact factor: 3.221
Authors: Denise Battaglini; Miquéias Lopes-Pacheco; Hugo C Castro-Faria-Neto; Paolo Pelosi; Patricia R M Rocco Journal: Front Immunol Date: 2022-04-27 Impact factor: 8.786
Authors: Mihaela Popescu; Adina Ghemigian; Corina Maria Vasile; Andrei Costache; Mara Carsote; Alice Elena Ghenea Journal: Diagnostics (Basel) Date: 2022-04-12