Free thyroxine level as an independent predictor of infection-related mortality in patients on peritoneal dialysis: A prospective multicenter cohort study

Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators

Research output: Contribution to journalArticle

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Abstract

Background: Previous studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients. Methods: Patients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models. Results: Among 235 PD patients, 31 (13.2%) deaths occurred during the mean follow-up period of 24 months. Infection (38.7%) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio [HR]=2.74, 95% confidence interval [CI] 1.27-5.90, P=0.01, and HR=6.33, 95% CI 1.16-34.64, P-0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR=3.30, 95% CI 1.15-9.41, P=0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively. Conclusions: fT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.

Original languageEnglish
Article numbere112760
JournalPloS one
Volume9
Issue number12
DOIs
Publication statusPublished - 2014 Dec 1

Fingerprint

Dialysis
Peritoneal Dialysis
dialysis
thyroxine
cohort studies
Thyroxine
Multicenter Studies
Cohort Studies
Mortality
Infection
infection
Hazards
Thyroid Hormones
confidence interval
Confidence Intervals
thyroid hormones
death
Cardiovascular Infections
Triiodothyronine
Thyrotropin

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators. / Free thyroxine level as an independent predictor of infection-related mortality in patients on peritoneal dialysis : A prospective multicenter cohort study. In: PloS one. 2014 ; Vol. 9, No. 12.
@article{3015a9b4c5884779a9602b34eceda238,
title = "Free thyroxine level as an independent predictor of infection-related mortality in patients on peritoneal dialysis: A prospective multicenter cohort study",
abstract = "Background: Previous studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients. Methods: Patients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models. Results: Among 235 PD patients, 31 (13.2{\%}) deaths occurred during the mean follow-up period of 24 months. Infection (38.7{\%}) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio [HR]=2.74, 95{\%} confidence interval [CI] 1.27-5.90, P=0.01, and HR=6.33, 95{\%} CI 1.16-34.64, P-0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR=3.30, 95{\%} CI 1.15-9.41, P=0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively. Conclusions: fT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.",
author = "{Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators} and Jung, {Hee Yeon} and Cho, {Jang Hee} and Jang, {Hye Min} and Kim, {Yon Su} and Kang, {Shin Wook} and Yang, {Chul Woo} and Kim, {Nam Ho} and Choi, {Ji Young} and Park, {Sun Hee} and Kim, {Chan Duck} and Kim, {Yong Lim} and Do, {J. Y.} and Song, {S. H.} and Kim, {S. E.} and Kim, {S. H.} and Kim, {Y. H.} and Lee, {J. S.} and Jin, {H. J.} and Lim, {C. S.} and Lee, {J. P.} and Chang, {J. H.} and Yoo, {T. H.} and Park, {J. T.} and Oh, {H. J.} and Park, {H. C.} and Chang, {T. I.} and Ryu, {D. R.} and Oh, {D. J.} and Chang, {Y. S.} and Kim, {Y. O.} and Kim, {S. H.} and Jin, {D. C.} and Kim, {Y. K.} and Kim, {H. Y.} and W. Kim and Lee, {K. W.} and Lee, {C. S.}",
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Free thyroxine level as an independent predictor of infection-related mortality in patients on peritoneal dialysis : A prospective multicenter cohort study. / Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators.

In: PloS one, Vol. 9, No. 12, e112760, 01.12.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Free thyroxine level as an independent predictor of infection-related mortality in patients on peritoneal dialysis

T2 - A prospective multicenter cohort study

AU - Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators

AU - Jung, Hee Yeon

AU - Cho, Jang Hee

AU - Jang, Hye Min

AU - Kim, Yon Su

AU - Kang, Shin Wook

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Choi, Ji Young

AU - Park, Sun Hee

AU - Kim, Chan Duck

AU - Kim, Yong Lim

AU - Do, J. Y.

AU - Song, S. H.

AU - Kim, S. E.

AU - Kim, S. H.

AU - Kim, Y. H.

AU - Lee, J. S.

AU - Jin, H. J.

AU - Lim, C. S.

AU - Lee, J. P.

AU - Chang, J. H.

AU - Yoo, T. H.

AU - Park, J. T.

AU - Oh, H. J.

AU - Park, H. C.

AU - Chang, T. I.

AU - Ryu, D. R.

AU - Oh, D. J.

AU - Chang, Y. S.

AU - Kim, Y. O.

AU - Kim, S. H.

AU - Jin, D. C.

AU - Kim, Y. K.

AU - Kim, H. Y.

AU - Kim, W.

AU - Lee, K. W.

AU - Lee, C. S.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background: Previous studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients. Methods: Patients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models. Results: Among 235 PD patients, 31 (13.2%) deaths occurred during the mean follow-up period of 24 months. Infection (38.7%) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio [HR]=2.74, 95% confidence interval [CI] 1.27-5.90, P=0.01, and HR=6.33, 95% CI 1.16-34.64, P-0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR=3.30, 95% CI 1.15-9.41, P=0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively. Conclusions: fT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.

AB - Background: Previous studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients. Methods: Patients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan-Meier curves and Cox proportional hazard models. Results: Among 235 PD patients, 31 (13.2%) deaths occurred during the mean follow-up period of 24 months. Infection (38.7%) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio [HR]=2.74, 95% confidence interval [CI] 1.27-5.90, P=0.01, and HR=6.33, 95% CI 1.16-34.64, P-0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR=3.30, 95% CI 1.15-9.41, P=0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively. Conclusions: fT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.

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