Department of Gastroenterology, Ankara Education and Research Hospital, Ankara, Turkey.
Wien Klin Wochenschr. 2012 Mar;124(5-6):154-9. doi: 10.1007/s00508-012-0125-1. Epub 2012 Feb 15.
Mortality rates of intensive care patients are quite high. The aim of this study was to determine the role, as well as to compare the value of several markers in predicting mortality in intensive care patients. Patient-wise, this is the largest study of its kind and the first that attempts to correlate the degree of thyroid hormone suppression with elevations in procalcitonin (PCT) levels.
In this study, a total of 417 patients were included in the final analysis, 235 of which were men (56%), and 182 were women (44%). Predictors of mortality that were investigated include age, APACHE II score, PCT, free triiodo-L-thyronine (fT3), free tetraiodothyronine/thyroxine (fT4) and thyroid stimulating hormone/thyrotropin (TSH).
High APACHE II score and low PCT levels, as well as suppression of fT3, fT4 and TSH levels were all found to be associated with higher mortality in our intensive care patients (p < 0.001). Suppression of thyroid hormones was also found to be reciprocally correlated with high APACHE II scores and PCT levels (p < 0.05).
Calculation of APACHE II score as well as measurement of PCT, fT3, fT4 and TSH levels may all be useful as predictors of mortality in intensive care patients.
重症监护患者的死亡率相当高。本研究旨在确定几种标志物在预测重症监护患者死亡率方面的作用，并对其进行比较。就患者个体而言，这是此类研究中规模最大的一次，也是首次尝试将甲状腺激素抑制程度与降钙素原（PCT）水平升高相关联。
本研究最终分析纳入了 417 例患者，其中 235 例为男性（56%），182 例为女性（44%）。研究中探讨的死亡率预测因素包括年龄、急性生理学与慢性健康状况评分系统 II（APACHE II）评分、PCT、游离三碘甲状腺原氨酸（fT3）、游离甲状腺素/四碘甲状腺原氨酸（fT4）和促甲状腺激素/甲状腺素（TSH）。
我们发现，APACHE II 评分高和 PCT 水平低，以及 fT3、fT4 和 TSH 水平受抑制，与重症监护患者的高死亡率相关（p<0.001）。甲状腺激素抑制也与高 APACHE II 评分和 PCT 水平呈反向相关（p<0.05）。
计算 APACHE II 评分以及测量 PCT、fT3、fT4 和 TSH 水平，可能均有助于预测重症监护患者的死亡率。
