Low triiodothyronine serum levels as a predictor of poor prognosis in burn patients

Gangemi, Ezio Nicola; Garino, Francesca; Berchialla, Paola; Martinese, Morena; Arecco, Federico; Orlandi, Fabio; Stella, Maurizio

doi:10.1016/j.burns.2007.10.002

Cited by 40 publications

(31 citation statements)

References 31 publications

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“…Low free T3 and high rT3 levels have also been associated with increased risk for mortality in patients in the intensive care unit (ICU) (89,105), hospitalized cardiac patients (82), patients with congestive heart failure (CHF) (40,92) and patients with liver cirrhosis (34). Others have reported that the presence of nonthyroidal illness portends worsened overall prognosis in patients with enterocutaneous fistulas (49) and in burn patients (42). There is limited literature regarding nonthyroidal illness in children hospitalized in the ICU (69).…”

Section: Treatment Of the Euthyroid Sick Syndromementioning

confidence: 98%

Euthyroid Sick Syndrome

Lee

Farwell

2016

Comprehensive Physiology

127

116

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In this review, we discuss the characteristics, pathophysiology, and therapeutic implications of the euthyroid sick syndrome. Multiple mechanisms have been identified to contribute to the development of euthyroid sick syndrome, including alterations in the iodothyronine deiodinases, thyroid-stimulating hormone secretion, thyroid hormone binding to plasma protein, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. The euthyroid sick syndrome appears to be a complex mix of physiologic adaptation and pathologic response to acute illness. The underlying cause for these alterations has not yet been elucidated. Treatment of the euthyroid sick syndrome with thyroid hormone to restore normal serum thyroid hormone levels in an effort to improve disease prognosis and outcomes continues to be a focus of many clinical studies, although currently available data do not provide evidence of a clear benefit of treatment.

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Section: Treatment Of the Euthyroid Sick Syndromementioning

confidence: 98%

Euthyroid Sick Syndrome

Lee

Farwell

2016

Comprehensive Physiology

127

116

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“…In this context, endocrine markers including high serum cortisol and/or low tri-iodothyronine levels have been correlated with poor outcome in critically ill patients (3,8,13,14). Interestingly, in children with meningococcal sepsis, non-surviving children had markedly higher GH levels and decreased IGF1 levels as compared with survivors (15).…”

Section: Introductionmentioning

confidence: 99%

Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients

Schuetz¹,

Müller²,

Nusbaumer³

et al. 2009

European Journal of Endocrinology

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Background: Circulating levels of GH are increased during critical illness and correlate with outcome in children with meningococcal sepsis. We assessed the prognostic implications of GH on admission and during follow-up in critically ill adult patients admitted to a medical intensive care unit. Materials and methods: We measured GH, IGF1 and IGF-binding protein3 (IGFBP-3) plasma concentrations in 103 consecutive critically ill patients and compared it with two clinical severity scores (APACHE II, SAPS II). Results: Median GH levels on admission were similar in septic (nZ53) and non-septic (nZ50) patients and about 7-fold increased in the 24 non-survivors as compared with survivors (9.50 (interquartile ranges (IQR) 3.53-18.40) vs 1.4 (IQR 0.63-5.04), P!0.0001). GH levels increased with increasing severity of sepsis (sepsis, severe sepsis, and septic shock, PZ0.019). By contrast, IGF1 and IGFBP-3 did not correlate with severity of disease or mortality. Logistic regression models showed that GH and both clinical scores were independent predictors of mortality with a similar prognostic accuracy (GH: area under the curve (AUC) 0.81 (95% confidence interval (CI), 0.71-0.92), APACHE II: AUC 0.71 (95% CI, 0.58-0.83), PZ0.16, SAPS II: AUC 0.75 (95% CI, 0.63-0.86, PZ0.36)). GH improved the prognostic accuracy of the APACHE II score to an AUC of 0.78 (95% CI, 0.66-090, PZ0.04) and tended to improve the SAPS II score to an AUC of 0.79 (95% CI, 0.67-0.90, PZ0.09). Conclusion: GH plasma concentrations on admission are independent predictors for mortality in adult critically ill patients and may complement existing risk prediction scores, namely the APACHE II and the SAPS II score.

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“…In the patient group, the mean age was 62 years, and female gender was 68.9% (31/45). TH profile is often altered in several diseases, and the degree of altered TH profile correlates with the severity of underlying disease (20,(26)(27)(28)(29)(30). In the present study, we assessed TH status and its relation to clinical severity in stress CMP.…”

Section: Ses Subgroupmentioning

confidence: 96%

“…There is increasing evidence that altered TH status in SES may have an influence on clinical outcome and cardiac function (1,(23)(24)(25)(26). It has been demonstrated that the degree of thyroid dysfunction was associated with severity of diseases, and low levels of biologically active TH predicted poor prognosis in several diseases (26)(27)(28)(29)(30).…”

Section: Introductionmentioning

confidence: 99%

“…It has been demonstrated that the degree of thyroid dysfunction was associated with severity of diseases, and low levels of biologically active TH predicted poor prognosis in several diseases (26)(27)(28)(29)(30). Previous studies have reported that low total T 3 levels were associated with increased mortality and impaired cardiac function and were strong prognostic predictors of death in heart disease (31)(32)(33).…”

Section: Introductionmentioning

confidence: 99%

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The relationship of thyroid hormone status with myocardial function in stress cardiomyopathy

Lee

Kang

Ryu

et al. 2009

European Journal of Endocrinology

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Objective: This study aimed to investigate thyroid hormone (TH) status and its relationship with myocardial function as well as clinical and biochemical parameters in stress cardiomyopathy (CMP). Methods: Forty-five patients with stress CMP (the patient group), 31 patients without stress CMP (the control II group), and 58 healthy subjects (the control I group) were included. Sick euthyroid syndrome (SES) was defined as low total triiodothyronine (T 3 ) with normal TSH levels. Results: In the patient group at admission, prevalence of SES was 62.2%. Compared with the control I group, the patient group had a decrease in left ventricular ejection fraction (LVEF) and systolic blood pressure (BP) and an increase in troponin-I, CK-MB, and B-type natriuretic peptide (BNP) levels. Total T 3 levels were reduced, and anti-thyroid peroxidase antibody (anti-TPO Ab) positivity, C-reactive protein (CRP) and cortisol levels were elevated. Total T 3 levels were associated with acute physiology and chronic health evaluation II (APACHE II) score, LVEF, systolic BP, and cortisol levels in multivariate analysis. In the control II group, total T 3 levels were not associated with any variables. In the SES (nZ28) and myocardial dysfunction (MDys, nZ27) subgroups, increased APACHE II score and BNP levels as well as decreased LVEF and systolic BP were significant. Total T 3 levels were reduced, and CRP, cortisol and catecholamines levels were elevated. In the MDys subgroup, anti-TPO Ab positivity and titer were increased. Conclusion: These results suggest that total T 3 levels may be associated with myocardial contractility, clinical severity, and cortisol levels. Thyroid autoimmunity may influence myocardial contractility in stress CMP.

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Low triiodothyronine serum levels as a predictor of poor prognosis in burn patients

Cited by 40 publications

References 31 publications

Euthyroid Sick Syndrome

Euthyroid Sick Syndrome

Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients

The relationship of thyroid hormone status with myocardial function in stress cardiomyopathy

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