A prognostic role for non-thyroidal illness syndrome in chronic renal failure:a systematic review and meta-analysis

Huaiyu Xiong; Peijing Yan; Qiangru Huang; Tiankui Shuai; Jingjing Liu; Lei Zhu; Jiaju Lu; Xiue Shi; Kehu Yang; Jian Liu

doi:10.1016/j.ijsu.2019.08.019

A prognostic role for non-thyroidal illness syndrome in chronic renal failure:a systematic review and meta-analysis

Int J Surg. 2019 Oct:70:44-52. doi: 10.1016/j.ijsu.2019.08.019. Epub 2019 Aug 19.

Authors

Huaiyu Xiong¹, Peijing Yan², Qiangru Huang¹, Tiankui Shuai³, Jingjing Liu³, Lei Zhu³, Jiaju Lu³, Xiue Shi⁴, Kehu Yang⁵, Jian Liu⁶

Affiliations

¹ Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.
² Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China.
³ Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China.
⁴ Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, China.
⁵ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, 730000, China; Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, 730000, China; Institute of Evidence Based Rehabilitation Medicine of Gansu Province, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China. Electronic address: kehuyangebm2006@126.com.
⁶ Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, 730000, China; The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, 730000, China. Electronic address: medecinliu@sina.com.

PMID: 31437639
DOI: 10.1016/j.ijsu.2019.08.019

Abstract

Background: Chronic renal failure (CRF) is a serious disease that has become a burden on global and local economics and public health. In addition, non-thyroidal illness syndrome (NTIS) has become increasingly more prevalent in CRF patients.

Materials and methods: A data search was conducted on the PubMed/Medline, Cochrane Library, Web of Science, Embase, and CBM databases to identify studies up to November 1st, 2018, that compared low T3 and normal T3 levels in patients with CRF. Data analysis was done by calculating the relative risks (RR) and 95% confidence intervals (95% CI) and continuous variables were described by weighted mean difference (WMD) and 95% CI. The efficacy outcomes included renal function and mortality. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess the quality of the cohort and cross-sectional studies, respectively. A funnel plot was used to identify publication bias.

Results: Seventeen studies with a total of 4593 patients were finally included in the analysis. Among the 17 studies, 11 reported the mortality of CRF patients with low T3 and normal T3 levels. Subgroups were assigned according to different follow-up times and different methods of treatment. The mortality rate in the low T3 group was much higher than in the normal T3 group. 11 studies reported creatinine (Cr) results in patients with low T3 and normal T3 levels and our analysis found no significant differences between the two groups (95%CI: 0.46-0.25; P-heterogeneity = 0.000; P = 0.559). Five studies reported uric acid results and we found no significant differences between the two groups (95%CI: 0.08-0.22; P-heterogeneity = 0.438; P = 0.377). Five studies reported the urea levels in the two groups and our analysis found no significant differences (95%CI: 1.60-1.23; I² = 0.0%; P-heterogeneity = 0.498;P = 0.798).

Conclusion: Low T3 had a greater impact on the short-term prognosis of patients with CRF than on the long-term prognosis. NTIS did not cause substantial kidney damage.

Keywords: Chronic kidney disease; Chronic renal failure; Low T3 syndrome; Meta-analysis; Non-thyroidal illness syndrome.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Cohort Studies
Cross-Sectional Studies
Euthyroid Sick Syndromes / mortality*
Humans
Kidney Failure, Chronic / complications
Kidney Failure, Chronic / mortality*
Prognosis