伴低T3综合征的急性髓系白血病患者的临床特征和预后分析

OBJECTIVE: To investigate the clinical features and prognosis of low triiodothyronine syndrome (LT3S) in patients with acute myeloid leukemia (AML). METHODS: A total of two 236 patients with AML who presented at the Jiangsu Provincial Hospital between January 2013 and December 2019 were included, and their data were retrospectively reviewed. The patients were divided into two groups, including the LT3S group and the non-LT3S group, according to their serum thyroxine level. The clinical characteristics and prognosis of the two groups were compared. RESULTS: Among the 236 patients, 62 (26.3％) patients had LT3S. Serum-free T3 level was positively correlated with albumin (r＝0.443, P<0.001) and hemoglobin (r＝0.187, P＝0.005) levels and negatively correlated with C-reactive protein (r＝−0.406, P<0.001) and lactate dehydrogenase (r＝−0.274, P<0.001) levels. The overall survival (OS) (7.5 months vs 29.9 months, P<0.001) and progression-free survival (PFS) (2.0 months vs 24.0 months, P<0.001) were significantly shortened in the LT3S group compared with the non-LT3S group. After propensity score matching, the OS (9.6 months vs 30.4 months, P＝0.010) and PFS (3.0 months vs 30.0 months, P＝0.014) were still significantly reduced in the LT3S group compared with the non-LT3S group. Therefore, LT3S was an independent risk factor for OS (HR＝2.553, 95％ CI 1.666–3.912, P<0.001) and PFS (HR＝1.701, 95％ CI 1.114–2.597, P＝0.014) in patients with AML. Subgroup analysis suggested that patients with LT3S had a worse prognosis in patients with AML who were obese, fragile, or treated with standard chemotherapy. CONCLUSION: The occurrence of LT3S reflects the poor clinical status and prognosis of patients with AML.