Correlation of Thyroid Hormone Profile with the Acute Physiology and Chronic Health Evaluation II Score as a Prognostic Marker in Patients with Sepsis in the Intensive Care Unit.

OBJECTIVES

Thyroid hormones regulate metabolism and homeostasis, and variations in thyroid hormone levels are common in chronically ill patients. Thyroid dysfunction, especially in critically ill patients admitted to the intensive care unit (ICU), is associated with adverse outcomes. This study was conducted to find a correlation between thyroid profile and sepsis and associate it with the acute physiology and chronic health evaluation II (APACHE II) score.

BACKGROUND

:A cross-sectional study was conducted from January 2015 to December 2015 at the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. A total of 100 patients aged 18 years or more fulfilling the sepsis criteria were included in the study. Patients were subjected to clinical examination followed by systemic examination. The clinical severity as well as the prediction of outcome was assessed by APACHE II score. Based on the outcome, the patients were divided into two groups, namely survivors and nonsurvivors. The data obtained were coded and entered into Microsoft excel spreadsheet and analyzed using SPSS 21. Continuous data were compared using independent sample t-test. The correlation of free triiodothyroxine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) with APACHE II score was done using Pearson's correlation coefficient. At 95% confidence interval, p < 0.05 was considered as statistically significant.

BACKGROUND

Out of 100 patients, 57 patients were men and 43 were women. The mean age of patients was 48.55 ± 18.09 years. Type 2 diabetes mellitus was the most common29 comorbid condition. Pneumonia was the primary diagnosis noted in 31patients followed by pyelonephritis.20 Most18 of the patients had APACHE II scores between 15 and 19. The mean APACHE II score was higher in nonsurvivors as compared to survivors (30.5 ± 7.24 vs. 16.92 ± 8.11; p < 0.001). In the study, 68 patients survived, while 32 of them died. Among nonsurvivors, APACHE II was inversely correlated with fT3 and fT4 levels, while TSH was positively correlated.

BACKGROUND

In ICU patients with sepsis, thyroid profile in combination with the APACHE II score may prove to be a better indicator of ICU morbidity and mortality more accurately than the APACHE II score alone.