Carreras Laura, Riaño Isolina, Vivanco Ana, Avello Noelia, Iglesias Tania, Rey Corsino
Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Pediatrics, University of Oviedo, Oviedo, Spain.
Front Pediatr. 2023 Mar 3;11:1142332. doi: 10.3389/fped.2023.1142332. eCollection 2023.
Non-thyroidal illness syndrome (NTIS) is considered to be associated with adverse outcomes in critically ill children.The hypothesis that thyroid hormones and inflammatory markers are associated with increased prediction of mortality risk scores is tested in this paper.
A prospective observational study was set up in a pediatric intensive care unit (PICU). One hundred and three patients were included. NTIS was defined as a low free triiodothyronine (FT3) value for the patient's age. Thyroid hormones levels and inflammatory markers were determined at admission: FT3, FT4 (free thyroxine), TSH (thyroid-stimulating hormone), rT3 (reverse triiodothyronine), CRP (C-reactive protein) and PCT (Procalcitonin). They were compared between children with a pediatric risk of mortality score PRISM-III >75th percentile (group A, = 25) and the rest (group B, = 78).
A FT4 value lower than 16.6 pmol/L showed an area under the curve (AUC) of 0.655 (0.56-0.78, = 0.02), with 76% sensitivity and 61.5% specificity to detect a high risk of mortality. A multiple regression analysis revealed that a FT4 lower than 16.6 pmol/L [OR: 4.92 (1.60-18.19), = 0.009] and having NTIS [OR: 6.04 (1.45-27.93), = 0.016] could predict a high risk of mortality.
In unselected critically ill children, FT4 and FT3 values at admission could be used as a good predictor of a high mortality risk. We have not achieved a predictive model that combines hormones with inflammatory markers.
非甲状腺疾病综合征（NTIS）被认为与危重症儿童的不良预后相关。本文检验了甲状腺激素和炎症标志物与死亡风险评分预测增加相关的假说。
在一家儿科重症监护病房（PICU）开展了一项前瞻性观察性研究。纳入了103例患者。NTIS被定义为患者年龄对应的游离三碘甲状腺原氨酸（FT3）值较低。在入院时测定甲状腺激素水平和炎症标志物：FT3、游离甲状腺素（FT4）、促甲状腺激素（TSH）、反三碘甲状腺原氨酸（rT3）、C反应蛋白（CRP）和降钙素原（PCT）。对儿科死亡风险评分PRISM-III>第75百分位数的儿童（A组，n = 25）和其余儿童（B组，n = 78）进行了比较。
FT4值低于16.6 pmol/L时，曲线下面积（AUC）为0.655（0.56 - 0.78，P = 0.02），检测高死亡风险的灵敏度为76%，特异度为61.5%。多元回归分析显示，FT4低于16.6 pmol/L [比值比（OR）：4.92（1.60 - 18.19），P = 0.009]以及患有NTIS [OR：6.04（1.45 - 27.93），P = 0.016]可预测高死亡风险。
在未经选择的危重症儿童中，入院时的FT4和FT3值可作为高死亡风险的良好预测指标。我们尚未建立一个将激素与炎症标志物相结合的预测模型。
