The Free Triiodothyronine, Gamma-Glutamyl Transpeptidase and Spontaneous Bacterial Peritonitis Index: A Novel Model for Predicting 1-Year Mortality in Patients with HBV-Related Hepatic Encephalopathy

Lin Lin; Ze-Yu Huang; Kai Liu; Xue-Cheng Tong; Zhi-Xin Zhang; Yuan Xue

doi:10.2147/HMER.S450638

The Free Triiodothyronine, Gamma-Glutamyl Transpeptidase and Spontaneous Bacterial Peritonitis Index: A Novel Model for Predicting 1-Year Mortality in Patients with HBV-Related Hepatic Encephalopathy

Hepat Med. 2024 Jan 22:16:1-9. doi: 10.2147/HMER.S450638. eCollection 2024.

Authors

Lin Lin^#^{1

2}, Ze-Yu Huang^#¹, Kai Liu^{1

3}, Xue-Cheng Tong^{1

3}, Zhi-Xin Zhang⁴, Yuan Xue^{1

3}

Affiliations

¹ Institute of Hepatology, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China.
² Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou, People's Republic of China.
³ Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou, People's Republic of China.
⁴ Department of Pulmonary Diseases, The Third People's Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background and aims: Hepatic encephalopathy (HE) is characterized by neuropsychiatric manifestations in patients with decompensated cirrhosis (DC) and/or liver failure. This study aimed to investigate the predictive value of thyroid hormone in patients with HE.

Methods: Patients with DC and HE were enrolled, and multivariate logistic analysis was conducted to analyze the risk factors for 1-year mortality.

Results: Among the 81 patients with HBV-related DC and HE, 9 (11.1%) died within 3 months, and 15 (18.5%) died within the first year. More patients with FT3 < 3.5pmol/L had ascites (33.3% vs 8.9%, P<0.01) and higher model for end-stage liver disease (MELD) (Z=3.669, P<0.01). Additionally, free triiodothyronine (FT3) levels were lower in the non-survivor group (P<0.01). FT3 exhibited a negative correlation with international normalized ratio and MELD (both P<0.05). Multivariate analysis revealed that FT3, gamma-glutamyl transpeptidase (GGT), and spontaneous bacterial peritonitis (SBP) were independent risk factors for 1-year mortality of HE. A new model incorporating FT3, GTT, and SBP demonstrated superiority to MELD based on the AUROC (0.9 and 0.752, P=0.04).

Conclusion: Low FT3, but not thyroid-stimulating hormone and free tetraiodothyronine, was identified as an independent risk factor for 1-year mortality in patients with DC and HE. The newly proposed prognostic model, which includes FT3, GTT, and SBP, holds significant predictive value.

Keywords: free triiodothyronine; gamma-glutamyl transpeptidase; hepatic encephalopathy; model for end-stage liver disease; mortality.

Grants and funding

This study was supported by the Project of Changzhou Health Commission (Grant No. QN202128), the Science and Technology Project of Changzhou (Grant No. CE20225040), and Leading Talent of Changzhou “the 14th Five-Year Plan” High-Level Health Talents Training Project (2022CZLJ021).