The combination of nonthyroidal illness syndrome and renal dysfunction further increases mortality risk in patients with acute myocardial infarction: a prospective cohort study

Jun-Wei Wang,Zhi-Gang Lu,Meng Wei,Lian-Xi Li,Jing Gao,Ying Ren,Cui-Chun Zhao

doi:10.1186/s12872-019-1027-1

Abstract

BackgroundBoth nonthyroidal illness syndrome and renal dysfunction are associated with increased mortality risk in acute myocardial infarction (AMI). However, it is unclear whether combined NTIS and renal dysfunction further increase mortality risk. Therefore, our aim is to investigate whether combined NTIS and renal dysfunction further increases mortality risk in patients with acute myocardial infarction (AMI).MethodsA total of 1295 inpatients with AMI were divided into normal group (n = 692), NTIS group (n = 139), renal dysfunction group (n = 304), and combined NTIS and renal dysfunction group (n = 160). Heart function, in-hospital, all-cause and cardiovascular mortality were compared among the four groups.ResultsAfter adjustment for age and sex, left ventricular ejection fraction was significantly lower in the combined group (48 ± 11%) than in the NTIS group (52 ± 10%, P = 0.017), the renal dysfunction group (52 ± 10%, P = 0.001) and the normal group (56 ± 8%, P < 0.001). After controlling for confounding factors, compared with the normal group, the NTIS and the renal dysfunction group represented higher risks of in-hospital mortality (OR: 3.643, P = 0.028; OR:3.135, P = 0.042, respectively), all-cause mortality (HR: 2.138, P = 0.007; HR: 2.050, P = 0.003, respectively), and cardiovascular mortality (HR:2.134, P = 0.042; HR:2.237, P = 0.010, respectively). Compared to those in the NTIS and the renal dysfunction group, the patients in the combined group showed a further increased risk for in-hospital mortality (OR:2.916, P = 0.039; OR:2.487, P = 0.036, respectively), all-cause mortality (HR: 1.939, P = 0.015; HR: 2.020, P = 0.002, respectively) and cardiovascular mortality (HR:2.420, P = 0.010; HR:2.303, P = 0.002, respectively).ConclusionsBoth NTIS and renal dysfunction increase short-term in-hospital mortality, and long-term all-cause and cardiovascular mortality risk in patients with AMI. Furthermore, the coexistence of NTIS and renal dysfunction presents further increased mortality risk in AMI patients.

Highlights

Both nonthyroidal illness syndrome and renal dysfunction are associated with increased mortality risk in acute myocardial infarction (AMI)
As the first manifestation of ischemic heart disease, acute myocardial infarction (AMI) can cause acute alteration in thyroid function, referred to as “nonthyroidal illness syndrome (NTIS)”, which is characterized by decreased free T3 levels (FT3) with normal or low free thyroxine (FT4) and thyroid-stimulating hormone (TSH) levels [3, 4]
The combined group was associated with higher prevalence of diabetes mellitus, higher white blood cell count (WBC) and C-reactive protein (CRP), less revascularization, and lower Hb compared to the Nonthyroidal Illness Syndrome (NTIS), the renal dysfunction and the normal group after controlling for age and sex

Summary

Introduction

Both nonthyroidal illness syndrome and renal dysfunction are associated with increased mortality risk in acute myocardial infarction (AMI). It is unclear whether combined NTIS and renal dysfunction further increase mortality risk. Our aim is to investigate whether combined NTIS and renal dysfunction further increases mortality risk in patients with acute myocardial infarction (AMI). The increased cardiovascular mortality in patients with renal insufficiency can be caused by cardio-renal syndrome, which is regarded as disorders of the heart and kidney whereby dysfunction in one organ may induce dysfunction of the other in acute or chronic conditions [17]

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