Kothiwale V A, Patil Pournima, Gaur Saurabh
Professor of Medicine, Vice Principal, Department of Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, Corresponding Author.
Associate Professor, Department of Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka.
J Assoc Physicians India. 2018 Jul;66(7):59-62.
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.
: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.
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.
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.
甲状腺激素调节新陈代谢和体内平衡，甲状腺激素水平的变化在慢性病患者中很常见。甲状腺功能障碍，尤其是入住重症监护病房（ICU）的危重症患者，与不良预后相关。本研究旨在找出甲状腺功能指标与脓毒症之间的相关性，并将其与急性生理与慢性健康状况评价II（APACHE II）评分相关联。
2015年1月至2015年12月在贝拉加维的KLES普拉巴卡尔·科雷博士医院及医学研究中心内科进行了一项横断面研究。共有100名年龄在18岁及以上符合脓毒症标准的患者纳入研究。患者先接受临床检查，随后进行全身检查。通过APACHE II评分评估临床严重程度以及预后预测。根据预后情况，将患者分为两组，即存活者和非存活者。所获数据进行编码后录入Microsoft excel电子表格，并使用SPSS 21进行分析。连续数据采用独立样本t检验进行比较。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）与APACHE II评分的相关性采用Pearson相关系数进行分析。在95%置信区间，p<0.05被认为具有统计学意义。
100名患者中，57名男性，43名女性。患者的平均年龄为48.55±18.09岁。2型糖尿病是最常见的合并症。31例患者的主要诊断为肺炎，其次是肾盂肾炎。大多数患者的APACHE II评分在15至19之间。非存活者的平均APACHE II评分高于存活者（30.5±7.24对16.92±8.11；p<0.001）。本研究中，68例患者存活，32例死亡。在非存活者中，APACHE II与fT3和fT4水平呈负相关，而与TSH呈正相关。
在脓毒症的ICU患者中，甲状腺功能指标与APACHE II评分相结合可能比单独使用APACHE II评分更准确地成为ICU发病率和死亡率的更好指标。
