Euthyroid sick syndrome and fasting hyperglycaemia in the elderly: Independent risk factors of in-hospital mortality. A prospective multicentric study [Sindrome del malato eutiroideo e iperglicemia a digiuno nel paziente geriatrico: Fattori di rischio indipendenti di mortalità intraospedaliera. Studio prospettico, multicentrico]

Euthyroid sick syndrome (NTIS) and fasting hyperglycaemia (NRFH) have been associated with an adverse clinical outcome in patients hospitalized for acute illness. Aim of this multicentric study was to evaluate the prevalence of NRFH and NTIS in acutely ill older patients admitted to either Geriatric or Internal Medicine Wards. The impact of NRFH and NTIS on in-hospital mortality was also assessed. Materials and methods. We studied 808 elderly patients consecutively admitted for acute, non-critical illness. Thyroid hormone profile and blood glucose level were evaluated after an overnight fast. On the basis of fasting glycaemia, patients were classified into group I (< 126 mg/dl), II (126-180 mg/dl) and III (> 180 mg/dl). Non-diabetics patients of groups II and III were considered affected by NRFH. Results. In the whole cohort the prevalence of NRFH was 18.6%. Among nondiabetic patients mean in-hospital survival resulted significantly shorter in those with NRFH (Kaplan-Meyer analysis log-rank2 12.5, p = 0.002). Moreover, all-cause mortality rate was 8.4, 18.0 and 32.1% in group I, II and III patients, respectively (p < 0.001), NRFH was an independent risk factor for in-hospital mortality (p < 0.05). In the Italian cohort, the prevalence of NTIS was 31.9%, emerging as a further independent risk factor for in-hospital mortality (p < 0.0001). By logistic regression analysis, NTIS was associated with a 5-fold increase in mortality (HR 5.1, CI 1.33-19.5). Conclusions. NRFH and NTIS are independent predictors of in-hospital mortality. These parameters should be considered for inclusion in the risk stratification of elderly patients admitted to acute care hospitals.