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Tytuł:
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The Association of TSH and Thyroid Hormones With Lymphopenia in Bacterial Sepsis and COVID-19.
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Autorzy:
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Grondman I; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
de Nooijer AH; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
Antonakos N; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece.
Janssen NAF; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
Mouktaroudi M; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece.
Leventogiannis K; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece.
Medici M; Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen, 6525 GA, Nijmegen, the Netherlands.; Academic Center for Thyroid Diseases and Departments of Internal Medicine and Epidemiology, Erasmus Medical Centre, 3015 GE, Rotterdam, the Netherlands.
Smit JWA; Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen, 6525 GA, Nijmegen, the Netherlands.
van Herwaarden AE; Department of Laboratory Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands.
Joosten LAB; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
van de Veerdonk FL; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
Pickkers P; Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525GA, Nijmegen, the Netherlands.
Kox M; Department of Intensive Care Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525GA, Nijmegen, the Netherlands.
Jaeger M; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.
Netea MG; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500 HB, Nijmegen, the Netherlands.; Department of Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany.
Giamarellos-Bourboulis EJ; 4th Department of Internal Medicine, National and Kapodistrian University of Athens, 124 62, Athens, Greece.
Netea-Maier RT; Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen, 6525 GA, Nijmegen, the Netherlands.
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Źródło:
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The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2021 Jun 16; Vol. 106 (7), pp. 1994-2009.
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Typ publikacji:
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Journal Article; Multicenter Study; Observational Study; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2017- : New York : Oxford University Press
Original Publication: Springfield, Ill. : Charles C. Thomas
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MeSH Terms:
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COVID-19/*complications
Euthyroid Sick Syndromes/*diagnosis
Lymphopenia/*immunology
Sepsis/*complications
Aged ; Aged, 80 and over ; COVID-19/blood ; COVID-19/immunology ; Euthyroid Sick Syndromes/blood ; Euthyroid Sick Syndromes/immunology ; Female ; Greece ; Humans ; Lymphocyte Count ; Lymphopenia/blood ; Lymphopenia/diagnosis ; Male ; Netherlands ; Retrospective Studies ; SARS-CoV-2/immunology ; Sepsis/blood ; Sepsis/immunology ; Thyroid Hormones/blood ; Thyroid Hormones/immunology ; Thyrotropin/blood ; Thyrotropin/immunology
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Contributed Indexing:
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Keywords: COVID-19; inflammation; lymphocyte; metabolism; sepsis; thyroid
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Substance Nomenclature:
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0 (Thyroid Hormones)
9002-71-5 (Thyrotropin)
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Entry Date(s):
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Date Created: 20210313 Date Completed: 20210628 Latest Revision: 20210628
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Update Code:
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20240104
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PubMed Central ID:
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PMC7989224
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DOI:
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10.1210/clinem/dgab148
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PMID:
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33713408
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Context: Lymphopenia is a key feature of immune dysfunction in patients with bacterial sepsis and coronavirus disease 2019 (COVID-19) and is associated with poor clinical outcomes, but the cause is largely unknown. Severely ill patients may present with thyroid function abnormalities, so-called nonthyroidal illness syndrome, and several studies have linked thyrotropin (thyroid stimulating hormone, TSH) and the thyroid hormones thyroxine (T4) and 3,5,3'-triiodothyronine (T3) to homeostatic regulation and function of lymphocyte populations.
Objective: This work aimed to test the hypothesis that abnormal thyroid function correlates with lymphopenia in patients with severe infections.
Methods: A retrospective analysis of absolute lymphocyte counts, circulating TSH, T4, free T4 (FT4), T3, albumin, and inflammatory biomarkers was performed in 2 independent hospitalized study populations: bacterial sepsis (n = 224) and COVID-19 patients (n = 161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts.
Results: Only T3 significantly correlated (ρ = 0.252) with lymphocyte counts in patients with bacterial sepsis, and lower concentrations were found in severe lymphopenic compared to nonlymphopenic patients (n = 56 per group). Severe lymphopenic COVID-19 patients (n = 17) showed significantly lower plasma concentrations of TSH, T4, FT4, and T3 compared to patients without lymphopenia (n = 18), and demonstrated significantly increased values of the inflammatory markers interleukin-6, C-reactive protein, and ferritin. Remarkably, after 1 week of follow-up, the majority (12 of 15) of COVID-19 patients showed quantitative recovery of their lymphocyte numbers, whereas TSH and thyroid hormones remained mainly disturbed.
Conclusion: Abnormal thyroid function correlates with lymphopenia in patients with severe infections, like bacterial sepsis and COVID-19, but future studies need to establish whether a causal relationship is involved.
(© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
