Relationship between free triiodothyronine and disease severity and prognosis in patients with hepatitis B cirrhosis

ZHAO Haiyan; HOU Ruijun; HONG Wei; SU Feng

doi:10.3969/j.issn.1007-8134.2025.01.004

Abstract：Objective To analyse the characteristics of thyroid hormone levels in patients with hepatitis B cirrhosis,and to explore the relationship between free triiodothyronine(FT3)and the severity and prognosis of hepatitis B cirrhosis patients.Methods Four hundred and twenty patients with hepatitis B cirrhosis who were hospitalized at The Affiliated Suqian of Xuzhou Medical University from January 2016 to June 2022,had complete medical records and completed follow-up,were included in the study.Analyze the correlation between thyroid hormone levels and Child Pugh score and Model for End Stage Liver Disease(MELD)score in patients with hepatitis B cirrhosis.Then compare the differences in thyroid hormone levels between the death group and the survival group of patients with hepatitis B cirrhosis.Subsequently,Cox regression analysis was used to identify risk factors associated with mortality in patients with hepatitis B cirrhosis.The predictive value of FT3 for mortality in patients with hepatitis B cirrhosis was analyzed using receiver operating characteristic curves.Finally,Kaplan Meier survival curves and Log rank tests were used to analyze the long-term survival status of patients.Results The incidence of low T3 and low FT3 is significantly increased in patients with decompensated hepatitis B cirrhosis.Thyroid hormones FT3,T3,T4,TSH are negatively correlated with MELD score and Child Pugh score.The FT3 of the death group of patients with hepatitis B cirrhosis was 3.46(2.96,4.33)pmol/L,which was lower than the survival group's 4.59(3.95,5.14)pmol/L(z=-6.374,P=0.000);The T3 of the death group was 1.35(1.10,1.70)nmol/L,which was lower than that of the survival group(1.77(1.51,2.04)nmol/L,(z=-5.583,P=0.000).Univariate Cox regression analysis and multivariate Cox regression analysis showed that FT3 is associated with mortality in patients with hepatitis B cirrhosis.The area under the ROC curve and(95％confidence interval)predicted by FT3 for patients with hepatitis B cirrhosis at 1,2,3,4,5 years and total mortality were 0.787(0.712,0.862),0.750(0.677,0.822),0.743(0.675,0.811),0.758(0.694,0.822),0.748(0.683,0.813),0.743(0.678,0.808),respectively,with no significant difference compared to MELD score and Child Pugh score.The mortality rate of patients in the FT3＜3.1 pmol/L group was significantly higher than that of patients in the FT3 ≥3.1 pmol/L group,(Log-rank P＜0.001).Conclusion Serum FT3 is correlated with the severity of hepatitis B cirrhosis,and its expression level is an important predictive tool for the long-term prognosis of hepatitis B cirrhosis patients,with certain clinical significance.