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Serum TSH may be a marker in predicting ACLF severity, mortality

In a cohort of patients with hepatitis B virus infection-related acute–on-chronic liver failure, thyroid stimulation hormone level was a useful indicator for determining severity and prognosis, according to published data.

“The purposes of this study were to investigate whether serum thyroid hormone levels [triiodothyronine₃, thyroxine₄, free (F)T₃ and FT₄] and thyroid stimulation hormone were changed in [acute–on-chronic liver failure] patients and to determine whether thyroid hormone levels can be used as prognostic markers for assessing severity and prognosis in [acute–on-chronic liver failure] patients,” the researchers wrote.

Researchers recruited 75 patients with HBV-related acute–on-chronic liver failure (ACLF; mean age, 42.8 ± 11.2 years) and 70 patients with chronic HBV (mean age, 39.6 ± 7.2 years) at Beijing 302 Hospital in China between January 2012 and June 2012. Serum thyroid hormone samples of the ACLF patients were collected and these patients were followed for 1 year.

Overall, the patients with HBV-related ACLF had lower T₃, T₄, FT₃ and FT₄ serum levels compared with the patients with chronic HBV (P < .001 for all). In all the patients, the model for end-stage liver disease (MELD) score correlated with all thyroid hormone and thyroid stimulation hormone (TSH) serum levels. A reverse correlation was observed between MELD score and T₃ (r = – 0.495; P < .001); T₄ (r = – 0.281; P < .001); FT₃ (r = – 0.219; P = .012); FT₃/FT₄ (r = – 0.444; P < .001); and TSH (r = – 0.498; P < .001) serum levels. However, a positive correlation was observed between MELD score and FT₄ (r = 0.286; P < .001).

Over the follow-up period, 31 patients with HBV-related ACLF died. The T₃, T₄ and TSH serum levels in non-surviving patients were lower compared with surviving patients (P = .016, P = .008 and P = .002), according to the research.

Analysis showed TSH level to be a factor in predicting mortality in patients with HBV-related ACLF (cutoff value = 0.38 IU/mL).

“Our study suggested that serum levels of thyroid hormones were altered in ACLF patients and were related to the severity of the diseases,” the researchers concluded. “The serum TSH levels may be a useful indicator for assessing severity and prognosis in ACLF.”

Disclosure: The researchers report no relevant financial disclosures.