title: Thyroid hormones as predictors of short- and long-term mortality in very old hospitalized patients.
abstract: BACKGROUND
  Although extensively investigated, the prognostic role of thyroid hormone abnormalities in older participants remains uncertain. We investigated the relationship between thyroid hormones and mortality during hospitalization and in a prolonged follow-up in frail older patients.
  
  
  METHODS
  A nonconcurrent cohort study was conducted by enrolling 450 participants hospitalized for an acute disease, who were classified into four groups (euthyroidism, hypothyroidism, hyperthyroidism, and low triiodothyronine [T3] syndrome), according to clinical and laboratory data. Multidimensional geriatric assessment variables were considered in order to identify short- and long-term predictors of death.
  
  
  RESULTS
  Participants were very old (mean age: 84 years) and frail, as indicated by severely impaired functional status, extensive comorbidity, high prevalence of dementia, and hospital mortality (8%). Prevalence of any thyroid dysfunction was 40.7%; 32% of participants had low T3 syndrome, which was associated with an excess hospital mortality risk (odds ratio: 2.7, 95% confidence interval [CI]: 1.1-6.5; p = .025), adjusted for demographic, clinical, functional, and laboratory data. Conversely, long-term mortality was unrelated to low T3 syndrome. In euthyroid participants, increasing levels of free thyroxine (FT4) were associated with a slightly greater mortality (hazard ratio, CI: 2.12, 0.99-4.54; p = .053) in adjusted Cox regression models.
  
  
  CONCLUSIONS
  This observational study on a cohort of very old, frail hospitalized patients gives support to the independent prognostic short-term, but not long-term, role of low T3 syndrome. Moreover, in older euthyroid participants, increasing levels of FT4 are a weak marker of poorer long-term survival. Thyroid hormones may help monitor changes in general health status and predict short- and long-term clinical outcomes in very old, frail patients.
authors: Unit of Geriatrics, Casteldelpiano Hospital, Azienda USL 9 Grosseto, Italy.
authors: Walter
authors: W
authors: De Alfieri
authors: Francesca
authors: F
authors: Nisticò
authors: Tiziano
authors: T
authors: Borgogni
authors: Fabio
authors: F
authors: Riello
authors: Fausto
authors: F
authors: Cellai
authors: Cinzia
authors: C
authors: Mori
authors: Nicola
authors: N
authors: Nante
authors: Mauro
authors: M
authors: Di Bari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood*; D015331:Cohort Studies; D015897:Comorbidity; D005067:Euthyroid Sick Syndromes / Q000097:blood / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000401:mortality; D007037:Hypothyroidism / Q000097:blood / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013959:Thyroid Diseases / Q000097:blood* / Q000401:mortality*; D013963:Thyroid Hormones / Q000097:blood*
chemical_list: D013963:Thyroid Hormones
keywords: Elderly; Mortality; Thyroid hormones