El-Ella Sohair Sayed Abu, El-Mekkawy Muhammad Said, El-Dihemey Mohamed Abdelrahman
Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin El-Kom, Menufia, Egipto.
Departamento de Pediatría, Facultad de Medicina, Universidad de Menufia, Shibin El-Kom, Menufia, Egipto.
An Pediatr (Engl Ed). 2019 Apr;90(4):237-243. doi: 10.1016/j.anpedi.2018.01.021. Epub 2018 Apr 5.
Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children.
A prospective observational study conducted on 70 critically ill children admitted into pediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24hours of PICU admission. Primary outcome was 30-day mortality.
NTIS occurred in 62.9% of patients but it took several forms. The most common pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P=.028). NTIS independently predicted mortality (OR=3.91; 95% CI=1.006-15.19; P=.0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR=16.9; 95% CI=1.40-203.04; P=.026). TSH was negatively correlated with length of PICU stay (r=-0.35, P=.011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1±0.66 versus 2.76±0.91pg/mL, P=.011).
NTIS is common among critically ill children and appears to be associated with mortality and illness severity.
危重病期间甲状腺激素的改变，即所谓的非甲状腺疾病综合征（NTIS），被认为具有预后价值。然而，儿科数据有限。本研究的目的是评估危重病儿童中NTIS的患病率和预后价值。
对70名入住儿科重症监护病房（PICU）的危重病儿童进行前瞻性观察研究。在入住PICU的24小时内测定游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）。主要结局是30天死亡率。
62.9%的患者出现NTIS，但其表现形式多样。最常见的模式是FT3降低而FT4和TSH正常（占患者的25.7%）。7.1%的患者FT3、FT4和TSH水平联合降低。三名患者出现TSH升高这一异常发现，这可能与疾病严重程度有关。与幸存者相比，非幸存者中FT4降低更为显著（50%对19.2%，P = 0.028）。NTIS可独立预测死亡率（OR = 3.91；95%CI = 1.006 - 15.19；P = 0.0491）。FT3、FT4和TSH同时降低是死亡率的最佳独立预测因素（OR = 16.9；95%CI = 1.40 - 203.04；P = 0.026）。TSH与PICU住院时间呈负相关（r = -0.35，P = 0.011）。接受多巴胺输注的患者FT3水平显著低于未接受多巴胺输注的患者（2.1±0.66对2.76±0.91pg/mL，P = 0.011）。
NTIS在危重病儿童中很常见，似乎与死亡率和疾病严重程度相关。
