A bstract Background To evaluate the association of thyroid hormones changes, including increased reverse triiodothyronine (rT3) level, with critically ill clinical patients´ mortality. Patients and methods This study analyzed the observational data prospectively collected over 8 months (2018) in an adult intensive care unit (ICU) in Brasilia, Brazil. All consecutive ICU-admitted clinical patients were included. Thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), free triiodothyronine (fT3), rT3, and thyroid-stimulating hormone (TSH) were collected within 48 hours of ICU admission. Patients with hypothyroidism or hyperthyroidism who were previously diagnosed were excluded. Results Of 353 included patients, age was 68.5 ± 19.0 years, sequential organ failure assessment (SOFA) score was 3.3 ± 2.9, and Acute Physiology and Chronic Health Evaluation II (APACHE II) was 17.1 ± 7.9. ICU mortality was 17.6% ( n = 62). Non-survivor patients had a higher incidence of increased rT3 (69.3 vs 59.2%, p = 0.042), lower incidence of low T4 (4.8 vs 9.7%, p = 0.045), and increased age (75.2 ± 16.3 years vs 67.1 ± 19.3 years, p = 0.001), SOFA (3.0 ± 0.4 vs 2.8 ± 2.6, p <0.001), and APACHE II (23.5 ± 7.5 vs 15.7 ± 7.2, p <0.001). Alterations in other thyroid hormones did not show association with mortality. Increased rT3 [odds ratio (OR): 2.436; 95% confidence interval (CI): 1.023–5.800; p = 0.020] and APACHE II (OR: 1.083, 95% CI: 1.012–1.158; p = 0.044) were associated with ICU mortality in the multivariate analysis. Conclusion Increased rT3 was independently associated with increased ICU mortality. In contrast, other thyroid hormone alterations did not show an association with mortality. Determining rT3 levels may be a helpful test to identify an increased risk for ICU mortality in clinical patients. How to cite this article da Silveira CDG, de Vasconcelos FPJ, Moura EB, da Silveira BTG, Amorim FFP, Shintaku LS, et al. Thyroid Function, Reverse Triiodothyronine, and Mortality in Critically Ill Clinical Patients. Indian J Crit Care Med 2021;25(10):1161–1166.
Introduction: Mucormycosis is a rare opportunistic fungal infection associated with high morbidity and mortality. Immunocompromised hosts are most at risk. Primary gastric mucormycosis is rarely reported, with rhinocerebral and pulmomary being most common sites for infection. Objectives/Aims: Here we describe a case of spontaneous gastric perforation due to invasive primary gastric mucormycosis infection in an immunocompetent host. No approval of the institutional review committee was needed as this was in the course of common clinical practice. Methods: A 28-year-old male with depression and anxiety, and subdural hematoma three months prior was found down after seizure. On arrival he was haemodynamically unstable, admitted to the intensive care unit (ICU) for management of sepsis and multisystem organ dysfunction, and initiated on renal replacement. Further evaluation revealed viscous perforation and pneumoperitoneum. An emergent exploratory laparotomy was performed. Surgical exploration revealed a 10 cm perforated gastric ulcer on the superior portion of greater curvature with necrosis, and necrotic posterior and superior portions of the stomach measuring 5 cm and 7 cm, respectively. He underwent splenectomy, total gastrectomy and was left in discontinuity. Histopathology of gastric tissue confirmed mucormycosis. Results: Liposomal amphotericin 5 mg/kg of B daily was initiated following surgical intervention. He underwent multiple intraabdominal wash outs, liver biopsy and had additional cultures obtained. A jejunostomy was placed for nutritional support. He had an exploration of the left neck with cervical oesophagostomy. The patient was transitioned to isavuconazoium but due to concerns for malabsorption via jejunostomy micafungin was continued concurrently. He completed his course and responded appropriately, with plans for proposed anastomosis. Conclusion: Few cases of invasive gastric mucormycosis associated spontaneous gastric perforation have been reported. Furthermore, occurrence in an immunocompromised host is minimal. Rapid and aggressive identification and intervention are crucial for minimising morbidity and mortality associated with mucormycosis.
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