scholarly journals Outcome of critically ill patients with non-thyroidal illness

2020 ◽  
Vol 11 (1) ◽  
pp. 47-51
Author(s):  
Faria Afsana ◽  
Kaniz Fatema ◽  
ASM Areef Ahsan ◽  
Bishwajit Bhowmik ◽  
Tasnima Siddique
Keyword(s):  
General Hospital ◽  
Critically Ill ◽  
Thyroid Function ◽  
Critically Ill Patients ◽  
Adaptive Response ◽  
Gastrointestinal Disease ◽  
Underlying Disease ◽  
Thyroid Function Tests ◽  
Nonthyroidal Illness ◽  
Hpt Axis

Background: During period of critical illness, there are diverse alterations in the hypothalamus-pituitarythyroid (HPT) axis. This diversity in critically ill patients and the etiological relationship between underlying disease and non-thyroidal illness (NTI) is poorly understood. The aims of this study were to examine the features of NTI and outcomes in critically ill patients admitted in Critical Care Medicine (CCM) Department, BIRDEM General Hospital. Methods: A total of 86 patients admitted to CCM department, BIRDEM General Hospital during the period of July to December 2015 , having nonthyroidal illness, detected by thyroid function tests during ICU stay were enrolled in this study. All patients discharged from hospital were followed up for a period of 6 months. Patients with known thyroid diseases or taking medications that affect thyroid function were excluded. Condition at hospital discharge and mortality in the ICU or later at home after discharge within next 6 months was assessed as outcomes. Results: Mean age of the study subjects was 63.87(±13.5)years and 45(52.3%)of the study subjects were female. Most of the study subjects had diabetes (84.88%) and hypertension (82.55%).Mean (±SD) of FT3 (pmol/l), FT4(pmol/l), TSH (uIU/ml) were 2.85(±1.35),12.74(±8.17) and 2.81(±8.57)respectively. Among the total study subjects 44.18% patients died in ICU and 2.32% patients after shifting to ward. Among the patients having pneumonia, Myocardial Infarction(MI) /Arrhythmia, Stroke, Sepsis and Gastrointestinal disease, 50.94% 51.02%, 56.0%,53.85%,37.50% died in hospital (ICU or after shifting toward).The 46 patients ,who were discharged from hospital were followed up for next 6 months. Conclusion: NTI is a transient adaptive response affecting individuals with acute and chronic illness and is more common among patients admitted in intensive care unit (ICU). The prognosis of patients having NTI depends on severity of thyroid dysfunction. Birdem Med J 2021; 11(1): 47-51

scholarly journals Erythrocyte zinc in hospital patients

2005 ◽  
Vol 42 (6) ◽  
pp. 448-452 ◽  
Author(s):  
L Batchat ◽  
S Vaja ◽  
D Treacher ◽  
M Kinerons ◽  
R Swaminathan
Keyword(s):  
Critically Ill ◽  
Thyroid Function ◽  
Critically Ill Patients ◽  
Geriatric Patients ◽  
Tissue Level ◽  
Hospitalized Patients ◽  
Thyroid Function Tests ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Hospital Patients

Background: Abnormal thyroid function tests (serum thyrotropin [TSH], free thyroxine [T4] and free triiodothyronine [T3]) are frequently seen in hospitalized patients. Assessment of thyroid function in these patients is difficult. It has been suggested that acutely ill patients may be hypothyroid at the tissue level. Erythrocyte zinc (EZn) has been shown to be increased in hypothyroidism. The aim of this study was to examine EZn as an index of thyroid status of hospital patients. Methods: In order to assess the thyroid status at tissue level, we measured EZn in 26 healthy subjects, 39 critically ill patients and 19 hospitalized geriatric patients. EZn was measured in young cells, as the effect of illness is likely to be seen in the newly formed cells. Result: TSH and free T3 were lower in critically ill patients and serum free T3 was lower in geriatric patients. EZn in young cells was higher in both patient groups (by 13% and 23%, respectively). EZn in old cells was also higher in the geriatric group. Conclusion: We conclude that EZn is higher in hospitalized patients, suggesting that these patients may be hypothyroid at the tissue level.

Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan

2021 ◽  
pp. 109980042110172
Author(s):  
Eman Mahmoud Qasim Emleek ◽  
Amani Anwar Khalil
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Scoring System ◽  
Elevated Serum ◽  
Underlying Disease ◽  
Disseminated Intravascular Coagulopathy ◽  
Period Prevalence ◽  
Lower Baseline ◽  
Intravascular Coagulopathy

Background: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. Methods: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. Results: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count ( t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level ( M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non–Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non–Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT ( U = 2,298, z = 5.7, p < 0.001), PTT ( U = 2,334, z = 2.0, p = 0.045) and INR ( U = 2,541, z = 5.1, p < 0.001) compared to those with non–Overt DIC. Conclusion: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Thiamine Levels During Intensive Insulin Therapy in Critically Ill Patients

2016 ◽  
Vol 32 (9) ◽  
pp. 559-564 ◽  
Author(s):  
Wouter van Snippenburg ◽  
Mariet G. J. Reijnders ◽  
Jose G. M. Hofhuis ◽  
Rien de Vos ◽  
Stephan Kamphuis ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Critically Ill ◽  
Intensive Insulin Therapy ◽  
Critically Ill Patients ◽  
Thiamine Deficiency ◽  
Gastrointestinal Disease ◽  
Glucose Levels ◽  
Gastrointestinal Pathology ◽  
Observational Prospective Cohort Study ◽  
Thiamine Level

Introduction: Thiamine is an essential cofactor in carbohydrate metabolism, and deficiency can therefore cause various organ dysfunctions. Little is known about the prevalence and possible worsening of thiamine deficiency in critically ill patients. In this study, we investigated the prevalence of thiamine deficiency at admission to the intensive care unit (ICU) and hypothesized that intensive insulin therapy, aimed at regulating glucose levels, increases thiamine utilization and therefore might cause or worsen deficiency in patients with limited thiamine stores. Materials and Methods: An observational prospective cohort study was carried out in a medical–surgical ICU in a general teaching hospital in Apeldoorn, the Netherlands. All adults who were treated during that time with intensive insulin therapy were included. Deficiency was defined as a thiamine level <100 nmol/L. No thiamine supplementation was administered except for normal amounts present in standard enteral feeding. Results: A total of 58 patients were available for analysis. Median thiamine level at admission was 111 nmol/L. Deficiency was present in 39.7% of patients and was significantly associated with the presence of gastrointestinal pathology and with recent surgery. Thiamine levels increased a median of 14 nmol/L in 48 hours. Only 3.4% of patients showed a predefined relevant decline in thiamine levels. Conclusion: Intensive insulin therapy does not appear to cause or worsen thiamine deficiency. However, based on the high prevalence of deficiency at admission, it might be warranted to supplement thiamine in all patients admitted to the ICU, especially when there is an underlying gastrointestinal disease or recent surgery.

scholarly journals Thyroid Function as a Predictive Tool for The Prognosis of Traumatic Patients Admitted in Surgery ICUs

2017 ◽  
Vol 5 (3) ◽  
pp. 14
Author(s):  
Ramin Azhough ◽  
Reza Movassaghi ◽  
Ali Farbod
Keyword(s):  
Thyroid Hormones ◽  
Critically Ill ◽  
Thyroid Function ◽  
Critically Ill Patients ◽  
Analytical Study ◽  
Serum Levels ◽  
Predictive Tool ◽  
Duration Of Hospitalization ◽  
Patient Prognosis ◽  
The Relationship

Background: APACHE Score is an important criterion for determining the patient prognosis, especially in critically ill patients. According to significantly changes in the serum levels of thyroidal hormones in patients, especially in critically ill patients, the aim of the present study was to evaluate the relationship between thyroid function and APACHE 4 score in the prognosis of the traumatic patients admitted in surgery ICU. Method & Material: In a descriptive-analytical study, 90 patients with multiple trauma were studied. Thyroid hormones and APACHE 4 Score were evaluated on 1st, 5th and10th days of admission for each patient. Their clinical features and duration of hospitalization, either in trauma unit or ICU, elation between thyroidal hormones and APACHE 4 Score, duration of hospitalization, and survival of patients were evaluated. Results: This study included 90 patients. A statistically significant relation was detected between thyroid hormones (TT3) and APACHE 4 Score and duration of hospitalization. Conclusion: TT3 might be utilized as a prognostic factor in the traumatic patients admitted to ICU. 

scholarly journals Thyroid Function Before, During, and After COVID-19

2020 ◽  
Author(s):  
Bernard Khoo ◽  
Tricia Tan ◽  
Sophie A Clarke ◽  
Edouard G Mills ◽  
Bijal Patel ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Case Analysis ◽  
Thyroid Function Tests ◽  
Acute Effects ◽  
Nonthyroidal Illness ◽  
Complete Case ◽  
Function Tests ◽  
National Health Service Trust ◽  
Thyroid Axis

Abstract Context The effects of COVID-19 on the thyroid axis remain uncertain. Recent evidence has been conflicting, with both thyrotoxicosis and suppression of thyroid function reported. Objective We aimed to detail the acute effects of COVID-19 on thyroid function and determine if these effects persisted on recovery from COVID-19. Design A cohort observational study was conducted. Participants and Setting Adult patients admitted to Imperial College Healthcare National Health Service Trust, London, UK, with suspected COVID-19 between March 9 to April 22, 2020, were included, excluding those with preexisting thyroid disease and those missing either free thyroxine (FT4) or thyrotropin (TSH) measurements. Of 456 patients, 334 had COVID-19 and 122 did not. Main Outcome Measures TSH and FT4 measurements were recorded at admission, and where available, in 2019 and at COVID-19 follow-up. Results Most patients (86.6%) presenting with COVID-19 were euthyroid, with none presenting with overt thyrotoxicosis. Patients with COVID-19 had a lower admission TSH and FT4 compared to those without COVID-19. In the COVID-19 patients with matching baseline thyroid function tests from 2019 (n = 185 for TSH and 104 for FT4), TSH and FT4 both were reduced at admission compared to baseline. In a complete case analysis of COVID-19 patients with TSH measurements at follow-up, admission, and baseline (n = 55), TSH was seen to recover to baseline at follow-up. Conclusions Most patients with COVID-19 present with euthyroidism. We observed mild reductions in TSH and FT4 in keeping with a nonthyroidal illness syndrome. Furthermore, in survivors of COVID-19, thyroid function tests at follow-up returned to baseline.

Influence of underlying disease on the outcome of critically ill patients with acute renal failure

2004 ◽  
Vol 21 (11) ◽  
pp. 848-853 ◽  
Author(s):  
T. H. Schroeder ◽  
M. Hansen ◽  
K. Dinkelaker ◽  
W. A. Krueger ◽  
B. Nohé ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Underlying Disease

scholarly journals Thyroid function in critically ill patients

2015 ◽  
Vol 3 (10) ◽  
pp. 816-825 ◽  
Author(s):  
Eric Fliers ◽  
Antonio C Bianco ◽  
Lies Langouche ◽  
Anita Boelen
Keyword(s):  
Critically Ill ◽  
Thyroid Function ◽  
Critically Ill Patients

scholarly journals INCIDENCE OF PNEUMONIA IN CRITICALLY ILL PATIENTS ON VENTILATOR IN BASAVESHWAR TEACHING AND GENERAL HOSPITAL

2014 ◽  
Vol 3 (60) ◽  
pp. 13374-13379
Author(s):  
Basavaraj R. Patil Raikod ◽  
Akash Awati ◽  
Sudhanva V Kinhal ◽  
Niraj Saraf
Keyword(s):  
General Hospital ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals Fecal Microbial Transplantation in Critically Ill Patients—Structured Review and Perspectives

Biomolecules ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1459
Author(s):  
Ivana Cibulková ◽  
Veronika Řehořová ◽  
Jan Hajer ◽  
František Duška
Keyword(s):  
Gut Microbiota ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fecal Microbiota Transplantation ◽  
Multiorgan Failure ◽  
Case Series ◽  
Underlying Disease ◽  
Fecal Microbiota ◽  
Host Susceptibility ◽  
Disease Case

The human gut microbiota consists of bacteria, archaea, fungi, and viruses. It is a dynamic ecosystem shaped by several factors that play an essential role in both healthy and diseased states of humans. A disturbance of the gut microbiota, also termed “dysbiosis”, is associated with increased host susceptibility to a range of diseases. Because of splanchnic ischemia, exposure to antibiotics, and/or the underlying disease, critically ill patients loose 90% of the commensal organisms in their gut within hours after the insult. This is followed by a rapid overgrowth of potentially pathogenic and pro-inflammatory bacteria that alter metabolic, immune, and even neurocognitive functions and that turn the gut into the driver of systemic inflammation and multiorgan failure. Indeed, restoring healthy microbiota by means of fecal microbiota transplantation (FMT) in the critically ill is an attractive and plausible concept in intensive care. Nonetheless, available data from controlled studies are limited to probiotics and FMT for severe C. difficile infection or severe inflammatory bowel disease. Case series and observational trials have generated hypotheses that FMT might be feasible and safe in immunocompromised patients, refractory sepsis, or severe antibiotic-associated diarrhea in ICU. There is a burning need to test these hypotheses in randomized controlled trials powered for the determination of patient-centered outcomes.

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