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Prognostic role of hypothyroidism and low free-triiodothyronine levels in patients hospitalized with acute heart failure

Internal and Emergency Medicine volume 16, pages 1477–1486 (2021)Cite this article

Abstract

Low thyroid function has been widely recognized as a potential cause of heart failure (HF), but the evidence about a possible association with in-hospital, all-cause mortality in patients with acute HF (AHF) is not consistent. This study sought to investigate the prevalence and prognostic role of hypothyroidism, overt and subclinical, and of low free-triiodothyronine (fT3) levels in patients hospitalized with AHF. We retrospectively analyzed consecutive 1018 patients who were hospitalized for AHF in a single academic medical center [Fondazione Policlinico A.Gemelli IRCCS, Rome, Italy] between January 1st 2016, and December 31st 2018. Patients were divided into three groups: normal thyroid function (n = 798), subclinical hypothyroidism (n = 105), and overt hypothyroidism (n = 115). The outcome was in-hospital, all-cause mortality. Patients were 81 years of age, 55% were females and nearly two-thirds of the patients were on New York Heart Association functional class III. The three most common cardiovascular comorbidities were coronary artery disease, hypertension, and atrial fibrillation with no differences across the three groups. Overall, 138 patients (14%) died during the hospital stay. The mortality rate was 27% among patients with overt hypothyroid, 17% among those with subclinical hypothyroidism, and 11% among euthyroid patients (p < 0.001). At a multivariate Cox regression model, overt hypothyroidism (HR 2.1, 95% CI 1.4–3.2) and fT3 levels < 1.8 pg/mL (HR 3.4, 95% CI 2.3–5.1) were associated with an increased likelihood of in-hospital death. No association was found with subclinical hypothyroidism. Among patients hospitalized with AHF, overt hypothyroidism and low fT3 levels are independent predictors of all-cause mortality during the hospital stay.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Internal Medicine, Fondazione Policlinico Universitario A.Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy

    Giuseppe De Matteis, Maria Livia Burzo, Davide Antonio Della Polla, Anna Petti & Giovanni Gambassi

  2. Emergency Department, Fondazione Policlinico Universitario A.Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy

    Marcello Covino & Francesco Franceschi

  3. Operative Unit of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy

    Carmine Bruno & Antonio Mancini

Authors
  1. Giuseppe De Matteis
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  2. Marcello Covino
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  5. Anna Petti
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  6. Carmine Bruno
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  7. Francesco Franceschi
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  8. Antonio Mancini
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  9. Giovanni Gambassi
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Contributions

MC: conceptualization, methodology, software, data curation, formal analysis, writing–review and editing. GM: conceptualization, validation, visualization, writing–original draft, writing–review and editing. MLB: validation, visualization, writing–original draft, writing–review and editing. DADP: software, formal analysis. AP: writing–review and editing. CB: writing–review and editing. FF: writing–review and editing. AM: conceptualization, methodology, writing–review and editing. GG: conceptualization, methodology, data curation, writing–review and editing, supervision.

Corresponding author

Correspondence to Giuseppe De Matteis.

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All authors declare no conflict of interest in this paper.

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The study was conducted in accordance with the principles expressed in the Declaration of Helsinki and was approved by the local ethical committee.

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Being a retrospective study performed on a database of anonymized patients, informed consent was not required.

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De Matteis, G., Covino, M., Burzo, M.L. et al. Prognostic role of hypothyroidism and low free-triiodothyronine levels in patients hospitalized with acute heart failure. Intern Emerg Med 16, 1477–1486 (2021). https://doi.org/10.1007/s11739-020-02582-y

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Keywords

  • Acute heart failure
  • Overt hypothyroidism
  • Subclinical hypothyroidism
  • Free-triiodothyronine