Z Gastroenterol 2010; 48 - P5_12
DOI: 10.1055/s-0029-1246557

Low free T3 levels are associated with 12 months survival in patients with advanced liver disease

F Grünhage 1, S Luhr 2, T Sauerbruch 2, F Lammert 1
  • 1Department of Internal Medicine II, Saarland University Hospital, Homburg, Germany, Homburg
  • 2Department of Internal Medicine I, University of Bonn, Bonn

Introduction It has been shown that patients with cirrhosis and low T3 levels are at higher risk of severe hepatic encephalopathy than euthyroid patients. However, it is unclear whether low thyroxin levels are also a risk factor for mortality in patients with liver cirrhosis. Thus, we prospectively evaluated the prognostic value of fT3 and fT4 levels for the prediction of survival in cirrhosis.

Patients and methods Patients with liver cirrhosis of mixed aetiology were included. Age, gender and follow-up times were recorded. Thyroid hormone levels (fT3 and fT4) and MELD variables (bilirubin, creatinine and INR) were determined, and survival status was recorded. Receiver operating characteristics, univariate and multivariate analysis were performed.

Results Overall, 48 patients (male: female 37: 11, age 54±11 years) were included. The majority of patients (n=24) suffered from alcoholic liver disease and chronic viral hepatitis (n=8), while other aetiologies were rare. During the median follow-up time of 263 days (17–491 days), 13 patients died (27%). Low fT3 and fT4 as well as high MELD were significant single predictors of survivals as determined by ROC analysis (AUC fT3=0.94, CI: 0.87–1.00; fT4=0.96, CI: 0.91–1.00; AUC MELD=0.90, CI: 0.81–0.99). A cut off level for fT3 of 1.71 pg/ml discriminated perfectly between survivors and non-survivors in a Kaplan-Meier analysis (P<0.01). However, multivariate regression analysis was underpowered to prove fT3 as an independent predictor of survival in addition to MELD.

Conclusions Our study clearly indicates that patients with liver cirrhosis and low fT3 or fT4 are at excess risk of death. Small independent effects of thyroid hormones from other predictors of mortality such as MELD cannot be excluded by our study. In addition, further studies are needed to clarify the outcome of patients under permanent substitution of thyroid hormones in comparison to patients without thyroid hormone medication.