Praveen N S, Modi K D, Sethi Bipin K, Murthy Jmk, Reddy Pawan K, Kandula Srinivas
Department of Endocrinology, Care Hospitals, Hyderabad, Telangana, India.
Department of Neurology, Care Hospitals, Hyderabad, Telangana, India.
Indian J Endocrinol Metab. 2023 Jan-Feb;27(1):50-55. doi: 10.4103/ijem.ijem_349_22. Epub 2023 Mar 3.
Transient thyroid hormone alterations are common during critical illness and are termed non-thyroidal illness syndrome (NTIS). We studied the prevalence of NTIS in the ICU setting and its impact on predicting mortality and other outcomes and compared it to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score.
The study included 119 consecutive patients admitted with a critical illness. APACHE II score was calculated. Total T3, total T4, TSH, free T3, and free T4 were measured at admission and after six weeks of discharge. NTIS and euthyroid groups were studied for ICU, hospital stays, mortality, readmission, and recovery. Predictors of mortality were compared between survivors and non-survivors.
The mean age was 60.15 ± 14.50 years with M:F = 84 (71%):35 (29%). NTIS was observed in 84 (71%), low T3 being the most common abnormality in 53 (63%). The occurrence of NTIS was significantly higher among non-survivors (28/30, 93%) versus survivors (56/89, 63%) ( = 0.002). Non-survivors showed significantly lower T3, TSH, and FT3/FT4 ratios and higher readmissions. NTIS group showed significantly greater ICU stay ( = 0.02) and had higher readmission rates ( = 0.032). Baseline T3 had the greatest power to predict mortality. APACHE II score also correlated significantly with mortality (19.60 ± 10.58 vs 11.99 ± 6.80, < 0.001). The area under the curve (0.677) for the T3 level was lower than the APACHE II score (0.760). After six weeks, 61% had recovered from NTIS.
NTIS was common amongst critically ill patients (71.5%), which reversed in 61% at six weeks. Low T3 was the most common abnormality and independently predicted mortality. Free T3/free T4 also significantly predicted mortality. The correlation between thyroid dysfunction and the severity of primary illness makes it an additional attractive low-cost marker of mortality.
危重症期间短暂性甲状腺激素改变很常见，被称为非甲状腺疾病综合征（NTIS）。我们研究了重症监护病房（ICU）环境中NTIS的患病率及其对预测死亡率和其他结局的影响，并将其与急性生理与慢性健康状况评分系统II（APACHE II）进行比较。
该研究纳入了119例连续收治的危重症患者。计算APACHE II评分。在入院时和出院六周后测量总T3、总T4、促甲状腺激素（TSH）、游离T3和游离T4。对NTIS组和甲状腺功能正常组的ICU住院时间、住院时间、死亡率、再入院率和恢复情况进行研究。比较幸存者和非幸存者之间的死亡率预测因素。
平均年龄为60.15±14.50岁，男性与女性比例为84（71%）:35（29%）。84例（71%）观察到NTIS，低T3是最常见的异常，有53例（63%）。非幸存者中NTIS的发生率（28/30，93%）显著高于幸存者（56/89，63%）（P = 0.002）。非幸存者的T3、TSH和FT3/FT4比值显著较低，再入院率较高。NTIS组的ICU住院时间显著更长（P = 0.02），再入院率更高（P = 0.032）。基线T3预测死亡率的能力最强。APACHE II评分也与死亡率显著相关（19.60±10.58 vs 11.99±6.80，P < 0.001）。T3水平的曲线下面积（0.677）低于APACHE II评分（0.760）。六周后，61%的患者NTIS恢复。
NTIS在危重症患者中很常见（71.5%），六周时61%的患者病情逆转。低T3是最常见的异常，可独立预测死亡率。游离T3/游离T4也显著预测死亡率。甲状腺功能障碍与原发性疾病严重程度之间的相关性使其成为另一个有吸引力且低成本预测死亡率的指标。
