Impact of thyroid dysfunction on short-term outcomes and long-term mortality in patients with pulmonary embolism. Issue 211 (March 2022)

• Record Type: Journal Article
• Authors: Pohl, Kristina R.; Hobohm, Lukas; Krieg, Valentin J.; Sentler, Carmen; Rogge, Nina I.J.; Steimke, Laura; Ebner, Matthias; Lerchbaumer, Markus; Hasenfuß, Gerd; Konstantinides, Stavros; Lankeit, Mareike; Keller, Karsten
• Is Part Of: Thrombosis research. Issue 211(2022)
• Page Start: 70
• Page End: 78
• Publication Date: 2022-03
• Subjects: Hypothyroidism -- Hyperthyroidism -- Pulmonary embolism -- Thyroid -- TSH; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2022.01.014
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: A large body of evidence suggest an impact of thyroid function on outcomes of cardiovascular diseases, but results for acute pulmonary embolism (PE) are sparse. Methods: We analysed the impact of hypothyroidism as well as hyperthyroidism on the short and long-term outcomes of patients with acute PE. The impact was compared to the group of euthyroid PE patients as reference group. Results: Overall, 831 PE patients (median age 69 [IQR 56–77] years; 52.2% females) were analysed. Among these, 734 patients (88.3%) were classified as euthyroid, 40 (4.8%) as hypothyroid and 57 (6.9%) as hyperthyroid. PE patients with hypothyroidism had higher rates of adverse in-hospital outcomes (37.5% vs. 11.6%, P < 0.001), PE-related (22.5% vs. 4.8%, P < 0.001) and all-cause in-hospital death (25.0% vs. 6.8%, P < 0.001), whereas hyperthyroidism did not affect in-hospital outcomes. Long-term mortality was higher in hypothyroidism (52.5% vs. 28.9%, P = 0.002) and hyperthyroidism (43.9% vs. 28.9%, P = 0.018) compared to euthyroid function. In the 750 normotensive PE patients, hyperthyroidism affected adverse in-hospital outcome (OR 2.58 [95%CI 1.12–5.97], P = 0.026) and PE-related in-hospital mortality (OR 3.50 [95%CI 1.10–11.17], P = 0.035) in comparison to euthyroid PE patients, while hypothyroidism showed no influence. Elevated fT4 (HR 1.75 [95%CI 1.16–2.63], P = 0.007) and reduced fT3 values (HR 2.51 [95%CI 1.48–4.28], P = 0.001) were associated with increased long-term mortality. Conclusion: Thyroid dysfunction had a substantial impact on short and long-term outcomes of patients with acute PE. Elevated fT4 and reduced fT3 values were significantly associated with increased long-term mortality in normotensive PE patients. Highlights: Thyroid dysfunction had a substantial impact on short and long-term outcomes of patients with PE. Hyperthyroidism affected adverse in-hospital outcome in normotensive PE patients. Hypothyroidism showed no influence on in-hospital outcomes in normotensive PE. Elevated fT4 and reduced fT3 were associated with increased long-term mortality in normotensive PE.