Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

2020 ◽  
Vol 33 (5) ◽  
pp. 653-659
Author(s):  
Jia Song ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Jiaying Dou ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Observational Study ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Threshold Value ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

scholarly journals Lipid and thyroid hormone levels in children with epilepsy treated with levetiracetam or carbamazepine: A prospective observational study

2019 ◽  
Vol 90 ◽  
pp. 15-19 ◽  
Author(s):  
Masahiro Nishiyama ◽  
Yuichi Takami ◽  
Yusuke Ishida ◽  
Kazumi Tomioka ◽  
Tsukasa Tanaka ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

Nonthyroidal illness

2011 ◽  
pp. 336-344
Author(s):  
R.P. Peeters
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Clinical Signs ◽  
Negative Energy ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Euthyroid Sick Syndrome ◽  
Thyroid Hormone Levels ◽  
Low Levels ◽  
Save Energy

A few hours after the onset of acute illness, marked changes in serum thyroid hormone levels occur. This is referred to as nonthyroidal illness (NTI). The most characteristic and persistent abnormality is a low level of serum triiodothyronine (T3). Despite these low levels of serum T3, patients usually have no clinical signs of thyroid disease. Other terms for this disease state have been used, e.g. the low T3 syndrome and the euthyroid sick syndrome. In addition to nonthyroidal illness, a low T3 in euthyroid patients is seen during caloric deprivation and after the use of certain types of medication (see Chapter 3.1.4). Low levels of thyroid hormone in hypothyroidism are associated with a decreased metabolic rate. Both in nonthyroidal illness and in fasting there is a negative energy balance in the majority of cases. Therefore the low levels of T3 during nonthyroidal illness and starvation have been interpreted as an attempt to save energy expenditure, and intervention is not required. However, this remains controversial and has been a debate for many years. In this chapter, the changes in thyroid hormone levels, the pathophysiology behind these changes, the diagnosis of intrinsic thyroid disease, and the currently available evidence whether these changes should or should not be corrected will be discussed (Box 3.1.5.1).

scholarly journals Erythrocyte selenium concentration predicts intensive care unit and hospital mortality in patients with septic shock: a prospective observational study

Critical Care ◽  
2014 ◽  
Vol 18 (3) ◽  
pp. R92 ◽  
Author(s):  
Nara Costa ◽  
Ana Gut ◽  
José Alexandre Pimentel ◽  
Silvia Maria Cozzolino ◽  
Paula Azevedo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Observational Study ◽  
Hospital Mortality ◽  
Prospective Observational Study ◽  
Selenium Concentration

Thyroid Hormone Levels and their Relationship to Survival in Children with Bacterial Sepsis and Septic Shock

2004 ◽  
Vol 17 (10) ◽  
Author(s):  
D. Yıldızdaş ◽  
N. Önenli-Mungan ◽  
Η. Yapıcıoğlu ◽  
A.K. Topaloglu ◽  
Y. Sertdemir ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Bacterial Sepsis ◽  
Hormone Levels ◽  
Thyroid Hormone Levels ◽  
Sepsis And Septic Shock

The relation of thyroid hormone levels and reduced insulin sensitivity to survival of patients with septic shock

2007 ◽  
Vol 2 (04) ◽  
Author(s):  
PG Halvatsiotis ◽  
S Stefanopoulou ◽  
A Kotanidou ◽  
S Orfanos ◽  
C Martinos ◽  
...  
Keyword(s):  
Septic Shock ◽  
Insulin Sensitivity ◽  
Thyroid Hormone ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

scholarly journals Evaluation of Thyroid Hormone Levels in Full-Term Neonates Presented with Septic Shock

2021 ◽  
Vol 8 (4) ◽  
pp. 168-174
Author(s):  
Dr. Dhananjay Singh ◽  
◽  
Dr. Jyotsana Shrivastava ◽  
Dr. Amit Agrawal ◽  
◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Mean Value ◽  
Full Term ◽  
Term Neonates ◽  
Hormone Levels ◽  
The Mean ◽  
Thyroid Hormone Levels ◽  
Thyroid Profile

Introduction: The incidence of neonatal sepsis in India is 38 per 1000 live births. Many authorsfound an association between altered thyroid hormone levels and septic shock in neonates and itmay be of prognostic importance in septic shock treatment. This study has been conducted to findthe relationship between thyroid profile and septic shock in neonates and also to compare thethyroid profile in survivor and non-survivor groups of septic shock patients. Methods: Thisanalytical prospective cohort study was conducted in the NICU of a tertiary care teaching institutionin central India. Full-term neonates with late-onset sepsis were included in this study and estimationof thyroid hormones (TSH, T3, T4, fT3, and fT4) was performed. These neonates were divided intothose with and without septic shock patients and levels of thyroid hormones were correlatedbetween these patients to find significant relations. The Vasoactive-Inotropic Score (VIS) score wascalculated. Results: A total of 195 full-term neonates were included in the study. The mean value ofTSH, T3, T4, fT3, and fT4 among neonates with septic shock were 5.27 μg/ml, 80.01 ng/dl, 6.36μg/dl, 1.40 pg/ml, and 1.40 μg/dl, respectively while the values were 5.29 μg/ml, 94.4 ng/dl, 7.25μg/dl, 1.84 pg/ml, and 1.43 μg/dl, respectively in septic neonates without shock. This difference wasstatistically significant except for TSH (p>0.05). The mean value of TSH, T3, T4, fT3, and fT4 amongseptic shock survivors were 5.27 μg/ml, 80.01 ng/dl, 6.36 μg/dl, 1.40 pg/ml, and 1.40 μg/dl and inseptic shock non-survivors were 2.40 μg/ml, 37.33 ng/dl, 3.86 μg/dl, 0.99 pg/ml, and 0.84 μg/dl,respectively (p<0.0001). Only T3 was found to be significantly co-related with VIS in septic shock inall the groups (<0.001). Conclusion: Our study suggests that TSH, T3, T4, fT3, and fT4 levels aresignificantly low in patients suffering from the septic shock which may vary in the case of TSH. Also,there is a significant decrease in thyroid profile among septic shock non-survivors as compared tosurvivors.

scholarly journals Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Toshikazu Abe ◽  
◽  
Shigeki Kushimoto ◽  
Yasuharu Tokuda ◽  
Gary S. Phillips ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Observational Study ◽  
Hospital Mortality ◽  
Prospective Observational Study ◽  
Antibiotic Administration ◽  
Coronary Syndrome ◽  
Sepsis And Septic Shock ◽  
The Impact ◽  
Sepsis Care

Abstract Background Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. Methods This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0–60, 61–120, 121–180, 181–240, 241–360, and 361–1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with “hospital” as the grouping variable. Results Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55–189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48–164 min)], time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39–180 min)] and longest in patients transferred from wards [120 min (62–226)]. Overall crude mortality was 23.4%, where patients in the 0–60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3–34.1%)], whereas those in the 61–120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5–26.6%)]. Differences in mortality were noted only between the 0–60 min and 61–120 min groups. Conclusions We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.

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