Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai, China.
J Pediatr Endocrinol Metab. 2020 May 26;33(5):653-659. doi: 10.1515/jpem-2019-0502.
Background Thyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock. Methods We performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission. Results Ninety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937-0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655-0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children. Conclusions Nonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.
甲状腺激素在适应危重病患者代谢功能中发挥着重要作用。甲状腺激素水平与脓毒性休克结局之间的关系尚不清楚。本研究旨在评估甲状腺激素对儿科脓毒性休克患者预后的预测价值。
我们在儿科重症监护病房（PICU）进行了一项前瞻性观察性研究。2017 年 8 月至 2019 年 7 月，我们招募了符合脓毒性休克标准的患者。收集临床和实验室指标，并在 PICU 入院时测量甲状腺激素水平。
符合纳入标准的 93 例患者纳入本研究。脓毒性休克患者非甲状腺病态综合征（NTIS）发生率为 87.09%（81/93）。多变量 logistic 回归分析表明，T4 水平与脓毒性休克患者住院死亡率独立相关（OR：0.965，95%CI：0.937-0.993，p=0.017）。T4 的受试者工作特征（ROC）曲线下面积（AUC）为 0.762（95%CI：0.655-0.869）。T4 为 58.71 nmol/L 的截断值具有 61.54%的敏感性和 85.07%的特异性，T4＜58.71 nmol/L 的患者死亡率较高（60.0%）。此外，T4 水平与儿科死亡风险 III 评分（PRISM III）和脓毒性休克儿童的血乳酸（Lac）水平呈负相关。
非甲状腺病态综合征在儿科脓毒性休克中很常见。T4 是住院死亡率的独立预测因子，PICU 入院时 T4＜58.71 nmol/L 的患者可能存在住院死亡风险。
