Abnormal Thyroid Function Is Associated With Lymphopenia in Bacterial Sepsis and COVID-19

Abstract Background: Lymphopenia is a key feature of immune dysfunction in bacterial sepsis and COVID-19 patients and is associated with poor clinical outcomes, but the cause is largely unknown. These severely ill patients may also present with thyroid function abnormalities, so-called non-thyroidal illness syndrome (NTIS), and several studies have suggested that TSH, thyroxin (T4) and triiodothyronine (T3) play a crucial role in the homeostatic regulation and function of lymphocyte populations. Aim: The purpose of this study was to test the hypothesis that abnormal thyroid function correlates with lymphopenia in severly ill patients with bacterial sepsis or COVID-19. Methods: Retrospective analysis of absolute lymphocyte counts and circulating TSH, T4, FT4, T3, albumin and inflammatory biomarkers was performed in two independent cohorts of bacterial sepsis (n=224) and hospitalized COVID-19 patients (n=35). Results: Only T3 correlated (rho=0.252, p-value: <0.001) with lymphocyte counts in the bacterial sepsis population and lower concentrations were found in severe lymphopenic compared to non-lympopenic patients (p-value: <0.001; n=56 per group). Severe lymphopenic COVID-19 patients (n=17) showed significantly lower plasma concentrations of TSH, T4, FT4 and T3 (p-value: 0.026, <0.001, 0.001, <0.001, respectively) compared to patients withouth lymphopenia (n=18), and demonstrated significantly increased values of the inflammatory parameters IL-6, C-reactive protein and ferritin (p-value: <0.001, 0.023, and 0.008, respectively). Remarkable, after one week follow-up, the majority of (12/15) COVID-19 patients showed quantitative recovery of their lymphocyte numbers, while TSH and thyroid hormones remained mainly disturbed. Conclusions: Abnormal thyroid function correlates with low lymphocyte counts in severe sepsis and COVID-19 patients, but future studies need to establish whether a causal relationship is involved.

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The association of TSH and thyroid hormones with lymphopenia in bacterial sepsis and COVID-19

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab148 ◽

2021 ◽

Author(s):

Inge Grondman ◽

Aline H de Nooijer ◽

Nikolaos Antonakos ◽

Nico A F Janssen ◽

Maria Mouktaroudi ◽

...

Keyword(s):

Thyroid Hormones ◽

Thyroid Function ◽

Plasma Concentrations ◽

Bacterial Sepsis ◽

Free T4 ◽

Reactive Protein ◽

Severe Infections ◽

Absolute Lymphocyte Counts ◽

And Function

Abstract Context Lymphopenia is a key feature of immune dysfunction in patients with bacterial sepsis and COVID-19 and associated with poor clinical outcomes, but the cause is largely unknown. Severely ill patients may present with thyroid function abnormalities, so-called non-thyroidal illness syndrome (NTIS), and several studies have linked TSH and the thyroid hormones thyroxine (T4) and triiodothyronine (T3) to homeostatic regulation and function of lymphocyte populations. Purpose To test the hypothesis that abnormal thyroid function correlates with lymphopenia in patients with severe infections. Methods Retrospective analysis of absolute lymphocyte counts, circulating TSH, T4, free T4 (FT4), T3, albumin and inflammatory biomarkers was performed in two independent hospitalized study populations: bacterial sepsis (n=224) and COVID-19 patients (n=161). A subgroup analysis was performed in patients with severe lymphopenia and normal lymphocyte counts. Results Only T3 significantly correlated (rho=0.252) with lymphocyte counts in patients with bacterial sepsis and lower concentrations were found in severe lymphopenic compared to non-lympopenic patients (n=56 per group). Severe lymphopenic COVID-19 patients (n=17) showed significantly lower plasma concentrations of TSH, T4, FT4 and T3 compared to patients without lymphopenia (n=18), and demonstrated significantly increased values of the inflammatory markers interleukin-6, C-reactive protein and ferritin. Remarkably, after one week follow-up, the majority (12/15) of COVID-19 patients showed quantitative recovery of their lymphocyte numbers, while 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.

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POS0826 SKIN LIMITED IGA VASCULITIS IN ADULTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1383 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 666.1-666

Author(s):

A. Hočevar ◽

J. Ostrovrsnik ◽

K. Perdan-Pirkmajer ◽

M. Tomsic ◽

Z. Rotar

Keyword(s):

Clinical Characteristics ◽

Systemic Disease ◽

Elevated Serum ◽

Skin Lesions ◽

Current Smoker ◽

P Value ◽

Symptom Duration ◽

Iga Vasculitis ◽

Reactive Protein

Background:IgA vasculitis (IgAV) could be limited to skin or evolve into a systemic disease, affecting characteristically joints, gastrointestinal tract and/or kidneys.Objectives:We aimed to look for differences between adult IgAV patients with disease limited to skin compared to systemic IgAV.Methods:Medical records of histologically proven adult IgAV cases, diagnosed between January 2010 and December 2020 at our secondary/tertiary rheumatology centre were analyzed.Results:During the 132-month observation period we identified 328 new IgAV cases (59.5% males, median (IQR) age 64.3 (45.1; 76.1) years). Ninety-four (40.2%) patients had skin limited disease, and the rest systemic IgAV.Clinical differences between skin limited and systemic adult IgAV are presented in table 1. Adults with IgAV limited to skin were significantly older, had less commonly skin lesions above the waistline and a lower level of C reactive protein compared to patients with a systemic disease. There were no differences in the frequency of skin necroses between the compared IgAV subgroups. The frequency of potential vasculitis triggers (prior infections, new medications, malignancy) was similar between the compared subgroups.Table 1.Clinical characteristics of IgA vasculitis patients with skin limited and systemic diseaseClinical characteristicsSkin limited IgAV (94)Systemic IgAV (234)P valueMale gender (%)54.361.50.263Age (years)*68.0 (55.0-80.5)61.5 (41.7-75.8)0.007Current smoker (%)13.821.80.123Antecedent infection (%)28.733.80.434New medication23.423.51.0History of cancer12.810.70.569Symptom duration (days)*7 (5-21)8 (5-14)0.756Purpura above waistline36.255.60.002Skin necroses (%)52.145.70.329ESR /mm/h) *32 (18-52)34 (17-53)0.873CRP (g/l) *13.5 (1-32)30 (11-68)<0.001Elevated serum IgA (%)50.649.10.892Legend: * median and IQR;Follow up data were available for 250 (76.2%) patients. During the follow up of median (IQR) 12.5 (6.8 – 22.4) months 35 patients relapsed (13/70 (18.6%) with skin limited IgAV and 22/180 (12.2%) with systemic IgAV, p= 0.224).Conclusion:Skin limited IgAV was associated with older age and less extensive skin puprura in adults. However, relapses of purpura were as common as in systemic IgAV.Disclosure of Interests:None declared

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Inflammatory Biomarker Score Identifies Patients with Six-Fold Increased Risk of One-Year Mortality after Pancreatic Cancer

Cancers ◽

10.3390/cancers13184599 ◽

2021 ◽

Vol 13 (18) ◽

pp. 4599

Author(s):

Alisa D. Kjaergaard ◽

Inna M. Chen ◽

Astrid Z. Johansen ◽

Børge G. Nordestgaard ◽

Stig E. Bojesen ◽

...

Keyword(s):

Plasma Concentrations ◽

High Plasma ◽

Carbohydrate Antigen ◽

Ductal Adenocarcinoma ◽

P Value ◽

Inflammatory Biomarker ◽

Reactive Protein ◽

Hazard Ratios ◽

Increased Risk ◽

One Year

We examined whether elevated plasma C-reactive protein (CRP), carbohydrate antigen (CA) 19-9, interleukin-6 (IL-6) and YKL-40, individually or combined, can identify poor survivors among patients with pancreatic ductal adenocarcinoma (PDAC). We measured CRP, CA 19-9, IL-6 and YKL-40 in 993 patients at the time of PDAC diagnosis. The biomarker score was the sum of biomarker categories, coded 0, 1 and 2 for low, intermediate and high plasma concentrations, respectively. High vs. low levels of CRP, CA 19-9 and IL-6 were each independently associated with a two-fold increased risk of one-year mortality. CRP performed best in patients with advanced and CA 19-9 in patients with low cancer stages. YKL-40 was not associated with mortality and, therefore, was not included in the biomarker score. Compared to the biomarker score = 0, the multifactorially adjusted hazard ratios for one-year mortality were 1.56 (95% confidence interval: 0.99–2.44) for score = 1, 2.22 (1.41–3.49) for score = 2, 3.44 (2.20–5.38) for score = 3, 5.13 (3.21–8.17) for score = 4 and 6.32 (3.84–10.41) for score = 5–6 (p-value for trend = 3 × 10−31). This score performed better than any single biomarker or combination of biomarkers when examined in similarly sized or other categories. In conclusion, a combination score of elevated CRP, CA 19-9 and IL-6 identified patients with six-fold higher one-year mortality.

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Serum Procalcitonic (PCT) Versus Serum C - Reactive Protein (CRP) for Severity of Organ Dysfunction in Sepsis

Academia Journal of Medicine ◽

10.47008/ajm.2020.3.2.6 ◽

2020 ◽

Vol 3 (2) ◽

pp. 24-27

Author(s):

Sirikonda Aishwarya ◽

Karankoti Raj Kumar ◽

Rallabhandi Sai Sri Harsha ◽

Patnala Chakradhar

Keyword(s):

Intensive Care ◽

Organ Dysfunction ◽

Plasma Concentrations ◽

Age Groups ◽

P Value ◽

C Reactive Protein ◽

Adequate Treatment ◽

Reactive Protein ◽

Group 4 ◽

Group 3

Background: Intensive care units (ICUs), despite advances in critical care nursing, have frequent issues with early diagnosis and adequate treatment. Recently discovered world-class procalcitonin (PCT), a revolutionary laboratory marker, has been shown to be useful in this regard. The objective is to Comparison of concentrations of serum procalcitonin (PCT) and c-reactive protein (CRP) with a comparable level of organ malfunction during sepsis and evaluation of the interaction between serum PCT and CRP concentrations with different organ malfunction occurrence in sepsis. Design: It is a Hospital-Based Prospective study. Participants and Setting: Fifty people were admitted to the intensive care unit of Gandhi Medical College. Subjects and Methods: The extent of sepsis-related organ impairment was evaluated with the sequential organ failure assessment (SOFA) on day 1. Patients were identified by category 1(0-6), category 2(7-12), group 3(13-18), and group 4(19-24) in 4 separate classes with varying organ impairment seriousness of sepsis. Serum PCT and CRP concentrations have been measured. Results: The majority of the patients belonged to the age groups of 60-69 years (30%) and 50-59 years (22%) Majority of the patients belonged to the Sofa group 1 around 42% followed by sofa group 2 with 38%, sofa group 3 with 16% and the least belonged to the sofa group 4 with 4%. The mean PCT and CRP concentration in those who survived was 14.73 ng/ml and 149.916mg/L respectively and in those who died were 45.76 ng/ml (p-value <0.001) and 183.584 mg/L (p-value 0.172) respectively. The linear correlation between PCT plasma concentrations and the four groups was significantly stronger than with CRP. Conclusion: In SOFA and serum PCT, The level of organ dysfunction and complications in sepsis patients is closely related to serum CRP levels.

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MO917INFLAMMATORY PARAMETERS IMPROVEMENT WITH CITRATE COMPARED TO ACETATE DIALYSATE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab102.0018 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jose Jesus Broseta Monzo ◽

Luis Carlos López Romero ◽

Diana Rodríguez ◽

Elena Guillen Olmos ◽

Pilar Sánchez-Pérez ◽

...

Keyword(s):

Cardiovascular Disease ◽

High Sensitivity ◽

Cardiovascular Death ◽

Dialysis Session ◽

Medium Term ◽

Reactive Protein ◽

Inflammatory Parameters ◽

Inflammatory Status ◽

Potential Benefits

Abstract Background and Aims The relation between inflammation and cardiovascular disease is well established. Dialysis patients are at a higher risk of cardiovascular death, mostly attributed to cardiovascular disease. This study evaluated the potential benefits of citrate (CD) vs. acetate dialysate (AD) regarding the patients’ inflammatory status. Method Single-center, cross-over, prospective study, with a follow-up of a total of 24 dialysis sessions, 12 with each dialysate. Blood samples were taken on the twelfth dialysis session with each type of dialysate. Every patient acted as its own control. The pre-dialysis parameters analyzed were procalcitonin (PCT), high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6). Results Pre-dialysis hsRCP [AD: 4,32 (1,27 – 12,16) vs. CD: 4,08 (0,98 – 8,65) mg/L, p = 0,031], PCT [AD: 0,44 (0,28 – 0,74) vs. CD: 0,38 (0,29 – 0,44) ng/mL, p = 0,037], and IL-6 [AD: 13,7 (7,85 – 29,03) vs. CD: 11,8 (5 – 27,13) pg/mL, p = 0,029] are significativly higher after twelve dialysis sessions with AD vs. CD. Conclusion Even in the medium term, the use of citrate instead of acetate as the dialysate acidifier, reduces the measured inflammatory parameters and could therefore be considered a more biocompatible dialysate option.

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Management of lateral epicondylitis (tennis elbow) by local infiltration of platelet rich plasma an outcome study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203715 ◽

2020 ◽

Vol 6 (5) ◽

pp. 963

Author(s):

Pradeep Kumar Kumawat ◽

Rajesh Goel ◽

Urmila Kumhar ◽

Rahul Parmar ◽

Rajesh Sharma ◽

...

Keyword(s):

Biological Therapy ◽

Tennis Elbow ◽

Platelet Rich Plasma ◽

Lateral Epicondylitis ◽

P Value ◽

Outcome Study ◽

Post Intervention ◽

Local Infiltration ◽

And Function

Background: Platelet-rich plasma (PRP) has been recently the emerging biological therapy in which a large pool of signals released from platelets producing a biological microenvironment for local and migrating cells for tissue regeneration. A prospective randomized observational study was done to assess the efficacy of autologous PRP injection in lateral epicondylitis of elbow.Methods: A total 100 patients of lateral epicondylitis were selected and treated from December 2015 to November 2017. VAS (visual analogue scale) and PRTEE (patient rated tennis elbow evaluation) scoring were used for clinical and functional assessment at pre-injection, 2nd week, 4th week, 3rd month and 6th month.Results: At the end of 6 months follow-up 61% patients were completely relieved of pain. 34% patients had mild pain that was significantly decreased (p value <0.0001) from mean VAS (75) and mean PRTEE (78.62) to mean VAS (6.05) and mean PRTEE (5.63). 5 patients were lost their 6 months follow-up. There was a significant increase in post intervention pain for few days in 70% patients. Recurrence rate of 0% was noted at the end of 6 months follow-up.Conclusions: An injection of PRP improves pain and function in patients suffering from lateral epicondylitis.

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Thyroid Function Test, C- Reactive Protein And Blood Lipids In Subclinical Hypothyroidism Patients Reporting At Surgical Wards

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2018005 ◽

2017 ◽

Vol 08 (01) ◽

pp. 17-20

Author(s):

Summaya Qazi ◽

Khalil ahmed Almani ◽

Rizwanullah Junaid Bhanbhro

Keyword(s):

Thyroid Function ◽

Subclinical Hypothyroidism ◽

Blood Lipids ◽

Inflammatory Marker ◽

University Hospital ◽

P Value ◽

C Reactive Protein ◽

Reactive Protein ◽

Serum T3 ◽

Serum Tsh

Objective: To investigate the thyroid function, C-reactive protein (CRP) and blood lipid profile in the subclinical hypothyroidism (SH) patients in surgical wards and outpatient department. Study design: Cross sectional study Place and Duration: Department of surgery, Isra University Hospital from August 2014 to May 2017. Materials and Methods: 100 subclinical hypothyroid cases and 100 controls were included according to inclusion and exclusion criteria. Serum TSH level > 6.2 (µIU /ml) with normal free T4 and T3 was considered as subclinical hypothyroidism. Venous blood was taken from ante cubital vein, centrifuged and processed. Sera were used for the assay of thyroid hormones, TSH, blood lipids and C-reactive protein. Data variables were analyzed by Statistix 8.0 (95% confidence interval) (P-value =0.05). Results: Age in controls and cases was noted as 51.3±12.5 and 50.8±11.95 years respectively. SH cases show serum T3, T4 and TSH as 0.89±0.18 µg/dl, 4.96±0.85 µg/dl and 11.95±2.85 µU/ml respectively. Serum total cholesterol, triglycerides and LDLc were raised with concomitant low HDLc in SH cases. C- reactive protein in SH cases was 6.91±3.38 ng/ml compared to controls 2.56±1.51 ng/ml (P=0.0001). Serum TSH showed negative correlation with HDLc, serum T3 and T4. Conclusion: The present study reports dyslipidemia with elevated inflammatory marker of C-reactive protein in subclinical hypothyroid patients.

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Applicability of thyroxine measurements and ultrasound imaging in evaluations of thyroid function in turtles

Journal of Veterinary Research ◽

10.2478/jvetres-2019-0029 ◽

2019 ◽

Vol 63 (2) ◽

pp. 267-273

Author(s):

Joanna Pajdak-Czaus ◽

Elżbieta Terech-Majewska ◽

Dagmara Będzłowicz ◽

Martyn Mączyński ◽

Wioletta Krystkiewicz ◽

...

Keyword(s):

Thyroid Hormone ◽

Thyroid Gland ◽

Thyroid Hormones ◽

Thyroid Function ◽

Ultrasound Imaging ◽

Ultrasound Examination ◽

Plasma Concentrations ◽

Physiological Homeostasis ◽

Low Levels ◽

And Function

AbstractIntroduction: The thyroid and parathyroid glands play a major role in maintaining physiological homeostasis in all vertebrates. Reptiles have plasma concentrations of thyroid hormones far lower than mammals. Low levels of these hormones in reptiles impede thyroid hormone detection with assays designed for the higher levels of mammals. The aim of this study was to explore teaming this with ultrasound imaging of the thyroid to appraise glandular function. Material and Methods: Thyroid function of four pond sliders was evaluated based on the results of T4 analyses and ultrasound. Results: The concentrations of T4 varied considerably between the examined animals from <9 nmol/L to >167.3 nmol/L. Ultrasound examination revealed uniform echogenicity and a smooth outline of the thyroid gland in all animals. Conclusion: Monitoring of thyroid function based on T4 and electrolyte concentrations is helpful in assessing the health and living conditions of reptiles, which is important in veterinary practice but problematic. Ultrasound examinations are useful in diagnosing changes in gland structure, such as tumours and goitres, and a combination of both methods supports comprehensive assessments of the anatomy and function of the thyroid gland.

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Metabolic Changes in SARS-CoV-2 Infection: Clinical Data and Molecular Hypothesis to Explain Alterations of Lipid Profile and Thyroid Function Observed in COVID-19 Patients

Life ◽

10.3390/life11080860 ◽

2021 ◽

Vol 11 (8) ◽

pp. 860

Author(s):

Damiano D'Ardes ◽

Ilaria Rossi ◽

Benedetta Bucciarelli ◽

Marco Allegra ◽

Francesco Bianco ◽

...

Keyword(s):

Lipid Profile ◽

Total Cholesterol ◽

Thyroid Function ◽

Thyroid Stimulating Hormone ◽

Lipid Lowering ◽

P Value ◽

Reactive Protein ◽

Admission Time ◽

Inflammatory State ◽

Baseline Values

It seems that during SARS-CoV-2 infection, total cholesterol, LDL-C, and HDL-C values decrease and lipids could play a fundamental role in viral replication. Moreover, it has been shown that SARS-CoV-2 infection could influence thyroid function. We performed a retrospective analysis of 118 hospitalized patients with COVID-19, comparing pre-infection lipid profile (53 patients) and thyroid-stimulating hormone (TSH) values (45 patients) to those measured on admission. Our aim was to evaluate whether SARS-CoV-2 infection could be involved in thyroid and lipid profile alterations and study possible correlations with disease severity and clinical outcome. Median baseline values at the admission time were: total cholesterol at 136.89 ± 42.73 mg/dL, LDL-C 81.53 ± 30.35 mg/dL, and HDL-C 32.36 ± 15.13 mg/dL; and triglycerides at 115.00 ± 40.45 mg/dL, non-HDL-C 104.53 ± 32.63 md/dL, and TSH 1.15 ± 1.08 μUI/mL. Median values of pre-infection total cholesterol, HDL-C, and TSH were significantly higher than those measured at the admission time (p value < 0.05). The C-reactive protein (CRP) negatively correlated with LDL-C (p = 0.013) and HDL-C (p = 0.05). Our data underline a possible impact of SARS-CoV-2 infection on thyroid function. Moreover it suggests a possible relation between COVID-19 and the lipid profile with a negative correlation between CRP, LDL-C, and HDL-C values, proposing the hypothesis that lipid lowering could follow the rising of the COVID-19 inflammatory state.

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P1523 Impact of different techniques for mitral valve repair on left ventricular function: a 2D/3D echocardiographic analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.946 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Cimino ◽

L I Birtolo ◽

V Maestrini ◽

F De Leo ◽

M Vinciguerra ◽

...

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Systolic Pressure ◽

Surgical Techniques ◽

Left Ventricular ◽

Pulmonary Artery Systolic Pressure ◽

P Value ◽

Lv Volumes ◽

And Function

Abstract Funding Acknowledgements None Aim Different surgical techniques are available for mitral valve (MV) repair in patients with degenerative severe mitral regurgitation (MR). Leaflet resection (LR) and neochordoplasty (NP), both including ring annuloplasty (RA), are the most frequently performed techniques for posterior mitral leaflet prolapse/flail repair. Despite NP technique is supposed to preserve LV physiology more than LR, it is unclear which technique provides the best haemodynamic pattern. In the present study, the results of the two different surgical techniques in terms of left ventricular (LV) dimension and function are investigated. Methods 23 consecutive patients who underwent MV surgical repair were enrolled. All patients underwent, before surgery and after 8 ± 2 months, 2D and 3D echocardiography with automatic (Heart Model, Philips) assessment of LV volumes and ejection fraction (EF), left atrial (LA) volume, right ventricular (RV) dimension and function, pulmonary artery systolic pressure (PASP), MR, tricuspid regurgitation (TR) and MVPG quantification. MR was corrected using 1) NP with polytetrafluoroethylene sutures and 2) triangular LR, both with RA. Patients were divided in 2 groups according to the surgical technique. Results: techniques were able to successfully correct MR. There were no significant differences in baseline echocardiogram and demographic characteristics between the two groups. There were no significant differences in terms of post-surgical MVPG between the two groups. In all patients a trend in reduction in LV dimension at follow-up was observed, but it was statistically significant only in NP patients (pre-surgical EDV 150 ± 41 VS post-surgical EDV 100 ± 27 ml, p = 0.03). Conclusions Both MV repair techniques showed a successful MV repair and an improvement in LV volumes at follow-up, especially in NP group. Further perspective studies are necessary to demonstrate the hypothesis of more physiological haemodynamic pattern associated with NP techniques. Echo parameters pre VS post MV Repair Parameter pre post p value LVEDV RN (ml) 150 ± 41 100 ± 27 0.03 LVESV RN (ml) 58 ± 20 46 ± 14 NS LVEF RN (%) 58 ± 8 55 ± 7 NS LVEDV RR (ml) 160 ± 58 118 ± 31 NS LVESV RR (ml) 62 ±11 51 ±13 NS LVEF RR (%) 59 ± 8 57 ± 4 NS EDV: end-diastolic volume, ESV: end-systolic volume, EF: ejection fraction, RN = Ring + Neochordae; RR= Ring + Resect.

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