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Ettleson MD, Bianco AC, Wan W, Laiteerapong N. Suboptimal Thyroid Hormone Replacement Is Associated With Worse Hospital Outcomes. J Clin Endocrinol Metab 2022; 107:e3411-e3419. [PMID: 35472082 PMCID: PMC9282363 DOI: 10.1210/clinem/dgac215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Indexed: 12/22/2022]
Abstract
CONTEXT Many patients with hypothyroidism receive suboptimal treatment that may affect hospital outcomes. OBJECTIVE This work aimed to identify differences in hospital outcomes between patients with and without hypothyroidism. METHODS A retrospective cohort study, using the propensity score-based fine stratification method to balance covariates, was conducted using a large, US-based, commercial claims database from January 1, 2008 to December 31, 2015. Participants included patients aged 64 years and younger who had a thyrotropin (TSH) level collected before a hospital admission. Covariates included age, sex, US region, type of admission, year of admission, and comorbidities. Exposure included clinical hypothyroidism, which was divided into 4 subgroups based on prehospitalization TSH level: low (TSH < 0.40 mIU/L), normal (TSH 0.40-4.50 mIU/L), intermediate (TSH 4.51-10.00 mIU/L), and high (TSH > 10.00 mIU/L). MAIN OUTCOME MEASURES INCLUDED length of stay (LOS), in-hospital mortality, and readmission outcomes. RESULTS A total of 43 478 patients were included in the final study population, of whom 8873 had a diagnosis of hypothyroidism. Those with a high prehospitalization TSH level had an LOS that was 1.2 days longer (95% CI, 1.1-1.3; P = .003), a 49% higher risk of 30-day readmission (relative risk [RR] 1.49; 95% CI, 1.20-1.85; P < .001), and a 43% higher rate of 90-day readmission (RR 1.43; 95% CI, 1.21-1.67; P < .001) compared to balanced controls. Patients with normal TSH levels exhibited decreased risk of in-hospital mortality (RR 0.46; 95% CI, 0.27-0.79; P = .004) and 90-day readmission (RR 0.92; 95% CI, 0.85-0.99; P = .02). CONCLUSION The results suggest suboptimal treatment of hypothyroidism is associated with worse hospital outcomes, including longer LOS and higher rate of readmission.
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Affiliation(s)
- Matthew D Ettleson
- Correspondence: Matthew D. Ettleson, MD, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, MC1027, Chicago, IL 60637, USA.
| | - Antonio C Bianco
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, Illinois 60637, USA
| | - Wen Wan
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Neda Laiteerapong
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA
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Lin JY, Kao PC, Tsai YT, Chung CH, Chien WC, Lin CY, Lu CH, Tsai CS. Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study. J Clin Med 2022; 11:jcm11133881. [PMID: 35807168 PMCID: PMC9267490 DOI: 10.3390/jcm11133881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/17/2022] [Accepted: 06/30/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p < 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p < 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.
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Affiliation(s)
- Jiun-Yu Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (J.-Y.L.); (Y.-T.T.)
| | - Pei-Chi Kao
- School of Public Health, University of Queensland, Brisbane, QLD 4072, Australia;
| | - Yi-Ting Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (J.-Y.L.); (Y.-T.T.)
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (W.-C.C.)
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (W.-C.C.)
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (J.-Y.L.); (Y.-T.T.)
- Correspondence: (C.-Y.L.); (C.-H.L.); (C.-S.T.); Tel.: +886-2-87927212 (C.-S.T.); Fax: +886-2-87927376 (C.-S.T.)
| | - Chieh-Hua Lu
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (C.-Y.L.); (C.-H.L.); (C.-S.T.); Tel.: +886-2-87927212 (C.-S.T.); Fax: +886-2-87927376 (C.-S.T.)
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (J.-Y.L.); (Y.-T.T.)
- Correspondence: (C.-Y.L.); (C.-H.L.); (C.-S.T.); Tel.: +886-2-87927212 (C.-S.T.); Fax: +886-2-87927376 (C.-S.T.)
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Pahuja M, Adegbala O, Mishra T, Akintoye E, Chehab O, Mony S, Singh M, Ando T, Abubaker H, Yassin A, Subahi A, Shokr M, Ranka S, Briasoulis A, Kapur NK, Burkhoff D, Afonso L. Trends in the Incidence of In-Hospital Mortality, Cardiogenic Shock, and Utilization of Mechanical Circulatory Support Devices in Myocarditis (Analysis of National Inpatient Sample Data, 2005-2014). J Card Fail 2019; 25:457-467. [PMID: 31035007 DOI: 10.1016/j.cardfail.2019.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/09/2019] [Accepted: 04/20/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocarditis may be associated with hemodynamic instability and portends a poor prognosis when associated with cardiogenic shock (CS). There are limited data available on the incidence of in-hospital mortality, CS, and utilization of mechanical circulatory support (MCS) devices in these patients. METHODS We queried the 2005-2014 National Inpatient Sample databases to identify all patients aged >18 years with myocarditis in the United States. RESULTS The number of reported cases of myocarditis per 1 million gradually increased from 95 in 2005 to 144 in 2014 (Pfor trend <.01). The trend and incidence of endomyocardial biopsy remained the same despite the increase in clinical diagnosis. Overall, in-hospital mortality was 4.43% of total admissions without a change in overall trend over the study period. We also observed a significant increase in the incidence of CS from 6.94% in 2005 to 11.99% in 2014 (Pfor trend <.01). There was a parallel increase in the utilization of advanced MCS devices during the same time period such as extracorporeal membrane oxygenation or percutaneous cardiopulmonary support (0.32% in 2005 to 2.1% in 2014; P< .01) and percutaneous ventricular assist devices such as Impella/tandem heart (0.176% in 2005 to 1.75% in 2014; P< .01). CONCLUSION Although the incidence of myocarditis has increased in the last decade, the in-hospital mortality has remained the same despite increases in the incidence of CS, possibly reflecting the benefits of increased usage of advanced MCS devices. We noted that increasing age, presence of multiple comorbidities and CS were associated with an increase in in-patient mortality.
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Affiliation(s)
- Mohit Pahuja
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Oluwole Adegbala
- Department of Internal Medicine, Engelwood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Engelwood, New Jersey
| | - Tushar Mishra
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Emmanuel Akintoye
- Division of Cardiology, Departement of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Omar Chehab
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Shruti Mony
- Division of Gastroenterology, University of South Florida, Tampa, Florida
| | - Manmohan Singh
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Tomo Ando
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Hossam Abubaker
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Ahmed Yassin
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Ahmed Subahi
- Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Mohamed Shokr
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Sagar Ranka
- Department of Internal Medicine, Cook County Hospital, Chicago, Illinios
| | - Alexandros Briasoulis
- Division of Cardiology, Departement of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tufts Medical Center
| | - Daniel Burkhoff
- Cardiovascular Research Foundation; Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York, New York
| | - Luis Afonso
- Division of Cardiology, Department of Inernal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan.
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