Thyroid hormone levels as a predictor of mortality in intensive care patients: A comparative prospective study

Taş, Adnan; Tetıker, Tamer; Beyazıt, Yavuz; Çelik, Hacer; Yeşil, Yusuf

doi:10.1007/s00508-012-0125-1

Cited by 14 publications

(14 citation statements)

References 32 publications

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“…[23] FT3, FT4, and TSH levels were all found to be associated with higher mortality in intensive care patients. [2425] Generally speaking, measurement of BUN, albumin, lactate, and FT3 levels might be useful as a predictor of mortality in intensive care patients. Those four biomarkers are expected to be included in model in the future.…”

Section: Discussionmentioning

confidence: 99%

Performance of Simplified Acute Physiology Score 3 in Predicting Hospital Mortality in Emergency Intensive Care Unit

Liang

et al. 2017

Chinese Medical Journal

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Background:Since the 1980s, severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs). Physicians used them for predicting mortality and assessing illness severity in clinical trials. The objective of this study was to assess the performance of Simplified Acute Physiology Score 3 (SAPS 3) and its customized equation for Australasia (Australasia SAPS 3, SAPS 3 [AUS]) in predicting clinical prognosis and hospital mortality in emergency ICU (EICU).Methods:A retrospective analysis of the EICU including 463 patients was conducted between January 2013 and December 2015 in the EICU of Peking University Third Hospital. The worst physiological data of enrolled patients were collected within 24 h after admission to calculate SAPS 3 score and predicted mortality by regression equation. Discrimination between survivals and deaths was assessed by the area under the receiver operator characteristic curve (AUC). Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed-to-expected numbers of deaths which is known as the standardized mortality ratio (SMR).Results:A total of 463 patients were enrolled in the study, and the observed hospital mortality was 26.1% (121/463). The patients enrolled were divided into survivors and nonsurvivors. Age, SAPS 3 score, Acute Physiology and Chronic Health Evaluation Score II (APACHE II), and predicted mortality were significantly higher in nonsurvivors than survivors (P < 0.05 or P < 0.01). The AUC (95% confidence intervals [CIs]) for SAPS 3 score was 0.836 (0.796–0.876). The maximum of Youden's index, cutoff, sensitivity, and specificity of SAPS 3 score were 0.526%, 70.5 points, 66.9%, and 85.7%, respectively. The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 demonstrated a Chi-square test score of 10.25, P = 0.33, SMR (95% CI) = 0.63 (0.52–0.76). The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 (AUS) demonstrated a Chi-square test score of 9.55, P = 0.38, SMR (95% CI) = 0.68 (0.57–0.81). Univariate and multivariate analyses were conducted for biochemical variables that were probably correlated to prognosis. Eventually, blood urea nitrogen (BUN), albumin, lactate and free triiodothyronine (FT3) were selected as independent risk factors for predicting prognosis.Conclusions:The SAPS 3 score system exhibited satisfactory performance even superior to APACHE II in discrimination. In predicting hospital mortality, SAPS 3 did not exhibit good calibration and overestimated hospital mortality, which demonstrated that SAPS 3 needs improvement in the future.

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Section: Discussionmentioning

confidence: 99%

Performance of Simplified Acute Physiology Score 3 in Predicting Hospital Mortality in Emergency Intensive Care Unit

Liang

et al. 2017

Chinese Medical Journal

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“…[17] Higher Apache 2 scores and poorer prognosis are reported for patients with low serum fT3 and fT4 concentrations. [18] Moreover, exogenous T3 replacement may reduce the mortality in surgery patients with sepsis. [19] Thyroid hormone and immune functions are closely interlinked.…”

Section: Discussionmentioning

confidence: 99%

Is Tri-iodothyronine a better choice than Activated Protein C in sepsis treatment?

Özozan

Ertorul²

2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Sepsis can be defined as a life-threatening organ dysfunction due to a dysregulated host response to infection. In sepsis, the coagulation cascade is activated and the balance shifts to the procoagulant side. Recently, the use of protein C is proposed for the treatment of sepsis. Another therapeutic agent that has been intensively studied is tri-iodothyronine. METHODS: This study aimed to compare the effects of activated protein C and tri-iodothyronine, which are administered at a single dose to sepsis-induced rats at the late phase. Leukocyte, platelet, hemoglobin and antithrombin-III concentrations and histopathological changes in the small intestine, liver and lung were evaluated at 24 hours. RESULTS: Single-dose intraperitoneal recombinant human APC (activated protein C) has a partial curative effect on hematological parameters in the late phase, while it is possible to state that it has significant therapeutic effects on hepatic and intestinal tissues, but more remarkably on the lung tissue. Tri-iodothyronine is also considered to be used for the treatment and has a strong potential to be a therapeutic agent. CONCLUSION: We observed that the T3 hormone has significantly limited and reduced the sepsis-related damage to hepatic and intestinal tissues, but especially the lung tissue. Tri-iodothyronine can be a good alternative to APC, which is partially allowed due to high cost and complication of bleeding in the treatment of sepsis.

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“…Many studies have shown that mortality rate increases or shows no change as suppression of thyroid hormone levels increases in intensive care unit patients. Some researchers found mortality associated with suppressed fT 3 , while another researcher suggested that suppressed fT 4 was associated with mortality, whereas some researchers have stated that both of them are associated with mortality; furthermore, fT 3 and fT 4 were better prognostic indicators than the APACHE II Scoring System (1,(22)(23)(24)(25)(26)(27). In contrast with those, it has been proposed that thyroid hormone levels are not indicators with respect to mortality (11).…”

Section: Discussionmentioning

confidence: 99%

“…The most common endocrine change in those patients is euthyroid sick syndrome. Underlying diseases, stress, ongoing medications of the patient, and impaired nutritional status may lead to primarily low free T 3 (f T 3 ) and also suppressed free T 4 (f T 4 ) and thyroid-stimulating hormone (TSH) (1). Patients hospitalized for clinical conditions, such as sepsis, malignancy, trauma, burns, myocardial infarction, and cerebrovascular events or for prolonged hunger status more than 24-36 hours, demonstrate remarkable changes in their hypothalamic-pituitary-thyroid axis and thyroid hormone levels (2)(3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Relationship between Thyroid Hormone Levels and Mortality in Old Patients Hospitalized in an Internal Medicine Intensive Care Unit from the Emergency Service

Topal¹,

Sebe²,

Ay³

et al. 2014

JAEM

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Objective: In our study, the purpose was to determine the relationship between thyroid hormones and mortality of patients over the age of 55 who were hospitalized in an intensive care unit from the emergency service. Material and Methods: This study was planned as a prospective, randomized study, and patients hospitalized in an intensive care unit from the emergency medicine department were enrolled in this study following ethics committee approval. A standard data collection form was used to collect the data. After confirmation from the patients and their relatives, we included 73 patients in our study: 48 (65.8%) males and 25 (34.2%) females. Blood samples were taken from each patient, and thyroid hormone levels were studied in our laboratory. The "SPSS for Windows version 18" program was used for statistical analysis of the data. Chi-square test was used to compare categorical measures between the groups. Mann-Whitney U-test and t-test were used to compare quantitative measurements between the groups. The log-rank test was performed under Kaplan-Meier survival analysis to determine the relationship between the estimated lifetime and free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH). Results: There was no statistically significant difference in mean ages and genders of patients who died and survived. The mean duration of hospitalization in the deceased patient group was lower than in the surviving patient group, but there was no statistically significant difference between the groups. According to the Kaplan-Meier survival analysis, the patients with low or high levels of fT3 were found to have a shorter median life expectancy. No significant relationship was found between mortality and fT4 TSH. Conclusion: According to our study, increased or decreased levels of fT3 in patients over the age of 55 without known thyroid disease, hospitalized in an intensive care unit from the emergency department, showed increased mortality. This study will be useful for emergency medicine physicians to be able to predict the mortality of patients and contribute to more clinical experience. FT3 levels can be used as a prognostic indicator after more detailed studies are completed.

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Thyroid hormone levels as a predictor of mortality in intensive care patients: A comparative prospective study

Abstract: Calculation of APACHE II score as well as measurement of PCT, fT3, fT4 and TSH levels may all be useful as predictors of mortality in intensive care patients.

Cited by 14 publications

References 32 publications

Performance of Simplified Acute Physiology Score 3 in Predicting Hospital Mortality in Emergency Intensive Care Unit

Performance of Simplified Acute Physiology Score 3 in Predicting Hospital Mortality in Emergency Intensive Care Unit

Is Tri-iodothyronine a better choice than Activated Protein C in sepsis treatment?

Investigation of the Relationship between Thyroid Hormone Levels and Mortality in Old Patients Hospitalized in an Internal Medicine Intensive Care Unit from the Emergency Service

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