title: Usefulness of serum thyroid-stimulation hormone (TSH) as a prognostic indicator for acute-on-chronic liver failure.
abstract: BACKGROUND AND RATIONALE FOR THE STUDY: To investigate thyroid function in patients with acute-on-chronic liver failure (ACLF) caused by hepatitis B virus infection and to determine whether thyroid hormone levels can be used as prognostic markers for assessing severity and prognosis of ACLF patients. We enrolled 75 patients with ACLF and70 patients with chronic hepatitis B (CHB). Continual serum samples were collected during hospitalization from the ACLF patients. The serum thyroid hormone levels (triiodothyronine [T3], thyroxine [T4], free (F)-T3, FT4, and thyroid stimulation hormone [TSH]) were measured by chemiluminescence. The Model for End-stage Liver Disease (MELD) score was used to assess severity.
  
  
  RESULTS
  ACLF patients showed significantly (p < 0.001) lower values of serum T3, T4, FT3/FT4 and TSH than CHB patients. The T3, T4, and TSH levels in ACLF patients were negatively correlated with the MELD score (T3: r = -0.495, p < 0.001; T4: r = -0.281, p < 0.001; TSH: r = -0.498, p < 0.001), suggesting that serum thyroid hormone levels reflect disease severity. At 1 year, 31 patients died. The T3 (p = 0.016), T4 (p = 0.008), and TSH (p = 0.003) levels in non-survivors were significantly lower than in survivors. The serum TSH level was a significant factor for predicting mortality in ACLF patients (optimal cutoff value = 0.38 IU/mL). The cumulative survival rate was decreased significantly when the serum TSH level was < 0.38 IU/mL (39.2%, p < 0.001).
  
  
  CONCLUSIONS
  Serum TSH level may be a useful indicator for assessing severity and prognosis in ACLF patients.
authors: Medical School of Chinese PLA, Beijing, China.
authors: Yichen
authors: Y
authors: Wu
authors: Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China.
authors: Shaoli
authors: S
authors: You
authors: Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China.
authors: Hong
authors: H
authors: Zang
authors: Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China.
authors: Hongling
authors: H
authors: Liu
authors: Clinical Laboratory Center, 302 Military Hospital of China, Beijing, China.
authors: Yuanli
authors: Y
authors: Mao
authors: Research and Technology Service Center, 302 Military Hospital of China, Beijing, China.
authors: Panyong
authors: P
authors: Mao
authors: Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China.
authors: Bing
authors: B
authors: Zhu
authors: Clinical Laboratory Center, 302 Military Hospital of China, Beijing, China.
authors: Jun
authors: J
authors: Xu
authors: Research and Technology Service Center, 302 Military Hospital of China, Beijing, China.
authors: Guoming
authors: G
authors: Xie
authors: Clinical Laboratory Center, 302 Military Hospital of China, Beijing, China.
authors: Jingxia
authors: J
authors: Guo
authors: Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China.
authors: Dongze
authors: D
authors: Li
authors: Medical School of Chinese PLA, Beijing, China.
authors: Shaojie
authors: S
authors: Xin
authors: Liver Failure Treatment and Research Center, 302 Military Hospital of China, Beijing, China.
authors: Zhihong
authors: Z
authors: Wan
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000821:virology; D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012720:Severity of Illness Index; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D015415:Biomarkers; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine