A Study On Association of Thyroid Hormone and Intensive Care Unit Mortality in Central India.
Life Sciences- Medicine
DOI:
https://doi.org/10.22376/ijlpr.2023.13.6.L51-L56Keywords:
Thyroid function test, ICU care, Mortality prediction, TSH, Low T3, APACHE II.Abstract
Thyroid dysfunction has been linked to mortality in patients hospitalized in the intensive care unit (ICU). We aim tostudy the thyroid hormone level changes in critically ill ICU patients and predict mortality based on thyroid hormone levels. Thisprospective observational study was conducted on 80 consecutive patients aged over 18yrs, from November 2021 to May 2022,in patients admitted to ICU at Chirayu medical college and Hospital, Bhopal, and followed up during their ICU stay. Samples weretested for T3, T4, and TSH on day 1 and day 7. In our study of 80 participants, 46(57.5%) were male, and 34(42.5%) were female.About 32 (40%) were non-survivors. The significance value (P value) of T3 levels on day 1 was 0.083, and on day 7 was 0.001; T4levels on day 1 were 0.85, and on day 7 was 0.001. Similarly, the significance of TSH levels on day 1 was 0.085, and on day 7 was0.001. Day 1 levels of T3 are significantly correlated with APACHE II Score, and Day 7 levels of T3, T4, and TSH significantlycorrelated with APACHE II scores in predicting the outcome of the patients with the higher significance of T3 compared to T4and TSH. Our study showed that low T3 level during critical illness increases mortality risk. Thyroid profiles can be used inpredicting mortality and as an independent factor in predicting the outcome of ICU patients.
References
Civetta JM. Prediction and definition of outcome. In: Civetta JM, Taylor RW, Kirby RR, editors. Critical care. Philadelphia: Lippincott-Raven; 1997. p. 127-47.
Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care. 2019;23(1):374. doi: 10.1186/s13054-019-2663-7, PMID 31775846.
Björck V, Påhlman LI, Bodelsson M, Petersson AC, Kander T. Morbidity and mortality in critically ill patients with invasive group A streptococcus infection: an observational study. Crit Care. 2020;24(1):302. doi: 10.1186/s13054-020-03008-z, PMID 32505194.
Bahtouee M, Eghbali SS, Maleki N, Rastgou V, Motamed N. Acute physiology and chronic health evaluation II score for the assessment of mortality prediction in the intensive care unit: a single-aacenter study from Iran. Nurs Crit Care. 2019;24(6):375-80. doi 10.1111/nicc.12401, PMID 30924584.
de Grooth HJ, Geenen IL, Girbes AR, Vincent JL, Parienti JJ, Oudemans-van Straaten HM. SOFA and mortality endpoints in randomized controlled trials: a systematic review and meta-regression analysis. Crit Care. 2017;21(1):38. doi: 10.1186/s13054-017-1609-1, PMID 28231816.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Apache II: A severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818-29. doi: 10.1097/00003246-198510000-00009, PMID 3928249.
Marx C, Petros S, Bornstein SR, Weise M, Wendt M, Menschikowski M et al. Adrenocortical hormones in survivors and nonsurvivors of severe sepsis: various time courses of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol. Crit Care Med. 2003 May;31(5):1382-8. doi 10.1097/01.CCM.0000063282.83188.3D, PMID 12771606.
Schuetz P, Müller B, Nusbaumer C, Wieland M, Christ-Crain M. Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients. Eur J Endocrinol. 2009 Feb;160(2):157-63. doi: 10.1530/EJE-08-0786, PMID 19022915.
Slag MF, Morley JE, Elson MK, Crowson TW, Nuttall FQ, Shafer RB. Hypothyroxinemia in critically ill patients as a predictor of high mortality. JAMA. 1981 Jan 2;245(1):43-5. doi 10.1001/jama.1981.03310260021020, PMID 7431627.
Rothwell PM, Lawler PG. Prediction of outcome in intensive care patients using endocrine parameters. Crit Care Med. 1995 Jan;23(1):78-83. doi: 10.1097/00003246-199501000-00015, PMID 8001391.
Rothwell PM, Udwadia ZF, Lawler PG. Thyrotropin concentration predicts outcomes in critical illness. Anesthesia. 1993 May;48(5):373-6. doi 10.1111/j.1365-2044.1993.tb07006.x, PMID 8317642.
Docter R, Krenning EP, de Jong M, Hennemann G. The sick euthyroid syndrome: changes in thyroid hormone serum parameters and metabolism. Clin Endocrinol (Oxf). 1993 Nov;39(5):499-518. doi 10.1111/j.1365-2265.1993.tb02401.x, PMID 8252737.
Lee S, Farwell AP. Euthyroid sick syndrome. Compr Physiol. 2016 Mar 15;6(2):1071-80. doi 10.1002/copy.c150017, PMID 27065175.
Chang CY, Chien YJ, Lin PC, Chen CS, Wu MY. Nonthyroidal illness syndrome and hypothyroidism in ischemic heart disease population: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2020 Aug 1;105(8):dgaa310. doi: 10.1210/clinem/dgaa310, PMID 32459357.
Rothberger GD, Gadhvi S, Michelakis N, Kumar A, Calixte R, Shapiro LE. The usefulness of serum triiodothyronine (T3) to predict outcomes in patients hospitalized with acute heart failure. Am J Cardiol. 2017 Feb 15;119(4):599-603. doi: 10.1016/j.amjcard.2016.10.045, PMID 28017303.
Liu J, Wu X, Lu F, Zhao L, Shi L, Xu F. Low T3 syndrome strongly predicts poor outcomes in patients with community-acquired pneumonia. Sci Rep. 2016 Mar 1;6:22271. doi: 10.1038/srep22271, PMID 26928863.
Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 Aug 11;365(6):506-17. doi: 10.1056/NEJMoa1102662, PMID 21714640.
Ray DC, Macduff A, Drummond GB, Wilkinson E, Adams B, Beckett GJ. Endocrine measurements in survivors and non-survivors from critical illness. Intensive Care Med. 2002 Sep;28(9):1301-8. doi: 10.1007/s00134-002-1427-y, PMID 12209281.
Wang F, Pan W, Wang H, Wang S, Pan S, Ge J. Relationship between thyroid function and ICU mortality: a prospective observational study. Crit Care. 2012 Jan 19;16(1):R11. doi: 10.1186/cc11151, PMID 22257427.
Kumar KV, Kapoor U, Kalia R, Chandra NS, Singh P, Nangia R. Low triiodothyronine predicts mortality in critically ill patients. Indian J Endocrinol Metab. 2013;17(2):285-8. doi: 10.4103/2230-8210.109715, PMID 23776904.
Suresh M, Srivastava NK, Jain AK, Nandy P. Thyroid dysfunction in critically ill patients in a tertiary care hospital in Sikkim, India. Thyroid Res Pract. 2017;14:58 62.
Gutch M, Kumar S, Gupta KK. Prognostic value of thyroid profile in critical care condition. Indian J Endocrinol Metab. 2018;22(3):387-91. doi: 10.4103/ijem.IJEM_20_18, PMID 30090732.
Chinga-Alayo E, Villena J, Evans AT, Zimic M. Thyroid hormone levels improve mortality prediction among patients admitted to the intensive care unit. Intensive Care Med. 2005;31(10):1356-61. doi: 10.1007/s00134-005-2719-9, PMID 16012806.
Zaid AE, Assy M, Salem H, Saad M, Herzalla M. Relationship between thyroid function and intensive care unit mortality in critically ill patients at Zagazig University hospital. Zagazig Univ Med J. 2015;21(2):1-10. doi: 10.21608/zumj.2015.4507.
Maldonado LS, Murata GH, Hershman JM, Braunstein GD. Do thyroid function tests independently predict survival in the critically ill? Thyroid. 1992;2(2):119-23. doi 10.1089/thy.1992.2.119, PMID 1525579.
Giri R, Yadav PK, Agarwal S, Kumar L. Assessment of the prognostic value of FT3, FT4, and TSH among critically ill patients. Int J Adv Med. 2021;8(6):775-80. doi: 10.18203/2349-3933.ijam20212098.
Economidou F, Douka E, Tzanela M, Nanas S, Kotanidou A. Thyroid function during critical illness. Hormones (Athens). 2011;10(2):117-24. doi 10.14310/horm.2002.1301, PMID 21724536.
Published
How to Cite
Issue
Section
Copyright (c) 2023 DrPravin Gulab Dandekar, Dr Pranay Anil Jain, Dr Shefali Jain
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
