The Association of TSH and Thyroid Hormones With Lymphopenia in Bacterial Sepsis and COVID-19.
J Clin Endocrinol Metab
; 106(7): 1994-2009, 2021 06 16.
Article
en En
| MEDLINE
| ID: mdl-33713408
ABSTRACT
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 (nâ =â 224) and COVID-19 patients (nâ =â 161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts.RESULTS:
Only T3 significantly correlated (ρâ =â 0.252) with lymphocyte counts in patients with bacterial sepsis, and lower concentrations were found in severe lymphopenic compared to nonlymphopenic patients (nâ =â 56 per group). Severe lymphopenic COVID-19 patients (nâ =â 17) showed significantly lower plasma concentrations of TSH, T4, FT4, and T3 compared to patients without lymphopenia (nâ =â 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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Síndromes del Eutiroideo Enfermo
/
Sepsis
/
COVID-19
/
Linfopenia
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Clin Endocrinol Metab
Año:
2021
Tipo del documento:
Article
País de afiliación:
Países Bajos