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Background  Both nonthyroidal illness syndrome and renal dysfunction are associated with increased mortality risk in acute myocardial infarction (AMI). However, it is unclear whether combined NTIS and renal dysfunction further increase mortality risk. Therefore, our aim is to investigate whether combined NTIS and renal dysfunction further increases mortality risk in patients with acute myocardial infarction (AMI).    Methods  A total of 1295 inpatients with AMI were divided into normal group ( n  = 692), NTIS group ( n  = 139), renal dysfunction group ( n  = 304), and combined NTIS and renal dysfunction group ( n  = 160). Heart function, in-hospital, all-cause and cardiovascular mortality were compared among the four groups.    Results  After adjustment for age and sex, left ventricular ejection fraction was significantly lower in the combined group (48 ± 11%) than in the NTIS group (52 ± 10%,  P  = 0.017), the renal dysfunction group (52 ± 10%,  P  = 0.001) and the normal group (56 ± 8%,  P  < 0.001). After controlling for confounding factors, compared with the normal group, the NTIS and the renal dysfunction group represented higher risks of in-hospital mortality (OR: 3.643,  P  = 0.028; OR:3.135,  P  = 0.042, respectively), all-cause mortality (HR: 2.138,  P  = 0.007; HR: 2.050,  P  = 0.003, respectively), and cardiovascular mortality (HR:2.134,  P  = 0.042; HR:2.237,  P  = 0.010, respectively). Compared to those in the NTIS and the renal dysfunction group, the patients in the combined group showed a further increased risk for in-hospital mortality (OR:2.916,  P  = 0.039; OR:2.487,  P  = 0.036, respectively), all-cause mortality (HR: 1.939,  P  = 0.015; HR: 2.020,  P  = 0.002, respectively) and cardiovascular mortality (HR:2.420,  P  = 0.010; HR:2.303,  P  = 0.002, respectively).    Conclusions  Both NTIS and renal dysfunction increase short-term in-hospital mortality, and long-term all-cause and cardiovascular mortality risk in patients with AMI. Furthermore, the coexistence of NTIS and renal dysfunction presents further increased mortality risk in AMI patients.    Electronic supplementary material  The online version of this article (10.1186/s12872-019-1027-1) contains supplementary material, which is available to authorized users.

bmc cardiovascular disorders

The combination of nonthyroidal illness syndrome and renal dysfunction further increases mortality risk in patients with acute myocardial infarction: a prospective cohort study