Abstract
Objective: Euthyroid sick syndrome (ESS) manifests by the decreased
level of serum free thyroid hormones and with the normal
or decreased secretion of thyroid-stimulating hormone. The
study aims to identify the prevalence of ESS in elderly patients
with sepsis and evaluate its possible effect on prognosis and
mortality.
Material and Methods: Two hundred and three patients diagnosed
with sepsis were prospectively evaluated. They were
divided into two groups, a geriatric group (≥65 years), and a control
group (<65 years). Patients with low free T3 (fT3) and/or free
T4 (fT4) were considered to have euthyroid-sick syndrome. The
demographic characteristics, comorbidities, laboratory results,
hospitalization data, intensive care unit (ICU) duration, treatment
outcomes, and mortality rates of the patients were recorded and
compared.
Results: The incidence of ESS was significantly higher in the
geriatric group (88.5% vs. 77.8%) (p=0.04). There was no difference
between the groups in regard to mortality rate and ICU
stay. However, 91.3% of deceased patients in the entire group
and all deceased patients in the geriatric group were ESS (+)
patients. The mean fT3 was significantly decreased in the deceased
patients, and ICU patients (p=0.017). Additionally, the
decreased levels of fT4 in both the entire group and the geriatric
group were significantly associated with mortality and ICU stay
(p-value: 0.020 and 0.019, respectively). Conclusions: The higher prevalence of ESS (88.5%) in elderly
patients with sepsis was clearly demonstrated. Additionally,
approximately two-fold higher mortality and ICU stay risk was
documented in the ESS (+) group. Thus, simply screening of ESS
in septic elderly patients will certainly contribute to treatment
decisions and early prediction of complicated clinical course and
poor prognosis.
References
- 1. Napolitano LM. Sepsis 2018: Definitions and guideline changes. Surgical infections 2018;19(2):117-25. [CrossRef] google scholar
- 2. Rowe TA, McKoy JM. Sepsis in older adults. Infectious Disease Clinics 2017;31(4):731-42. [CrossRef] google scholar
- 3. Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJ et al. Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection: a systematic review and meta-analysis. Annals of internal medicine 2018;168(4):266-75. [CrossRef] google scholar
- 4. Ganesan K, Wadud K. Euthyroid sick syndrome. StatPearls Publishing; 202 2 Jan-. www.ncbi.nlm.nih.gov/books/ NBK482219/ google scholar
- 5. Guo J, Hong Y, Wang Z, Li Y. Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Unit and Related Risk Factors. Front Endocrinol (Lausanne) 2021;12:656641. [CrossRef] google scholar
- 6. Polini A, Iglesias P, Dardano A, Tognini S, Castiglioni M, Diez JJ et al. Euthyroid sick syndrome and fasting hyperglycaemia in the elderly: Independent risk factors of in-hospital mortality. A prospective multicentric study. G Gerontol 2012;60(2):61-9. http://hdl.handle.net/11568/158606 google scholar
- 7. Boonmee P, Ruangsomboon O, Limsuwat C, Chakorn T. Predictors of mortality in elderly and very elderly emergency patients with Sepsis: a retrospective study. West J Emerg Med 2020;21(6):210. [CrossRef] google scholar
- 8. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE open medicine. 2019;7:2050312119835043. [CrossRef] google scholar
- 9. Cheng HH, Chen FC, Change MW, Kung CT, Cheng CY, Tsai TC, et al. Difference between elderly and non-elderly patients in using serum lactate level to predict mortality caused by sepsis in the emergency department. Medicine 2018;97(13):e0209. [CrossRef] google scholar
- 10. Preechasuk L, Suwansaksri N, Ipichart N, Vannasaeng S, Permpikul C, Sriwijitkamol A. Hyperglycemia and glycemic variability are associated with the severity of sepsis in nondiabetic subjects. J Crit Care 2017;38:319-23. [CrossRef] google scholar
- 11. Sim YS, Jung H, Shin TR, Kim DG, Park SM. Mortality and outcomes in very elderly patients 90 years of age or older admitted to the ICU. Respir Care 2015;60(3):347-55. [CrossRef] google scholar
- 12. Biyikli E, Kayipmaz AE, Kavalci C. Effect of platelet-lymphocyte ratio and lactate levels obtained on mortality with sepsis and septic shock. Am J Emerg Med 2018;36(4):647-50. [CrossRef] google scholar
- 13. Arihan O, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J et al. Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU. PloS one 2018;13(1):e0191697. [CrossRef] google scholar
- 14. Kagansky N, Tal S, Levy S. Euthyroid sick syndrome in older people. Rev Clin Gerontol 2001;11(1):1-4. [CrossRef] google scholar
- 15. Zhu C, Zhu J, Liang Z, Kong Y, Liu Y. The correlation of metabolic syndrome with low triiodothyronine syndrome, subclinical hypothyroidism and hyperhomocysteinemia in the elderly. Chines Journal of Geriatrics 2018;37(9):988-91. [CrossRef] google scholar
- 16. Padhi R, Kabi S, Panda BN, Jagati S. Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis. International journal of critical illness and injury science 2018;8(3):165. [CrossRef] google scholar
- 17. Neamtu ML, Dobrota L, Neamtu MB, Neamtu CB, Diac FS. 966 the nonthyroidal illness syndrome in septic children. Archives of Disease in Childhood 2012;97(2):A276. [CrossRef] google scholar
- 18. Ergan B, Ergün R, Aydin K, Ergün D. Nonthyroidal illness syndrome in severe chronic obstructive pulmonary disease exacerbations in the elderley. Turkish Journal of Geriatrics/ Türk Geriatri Dergisi 2016;19(2):67-73. [CrossRef] google scholar
- 19. Yanni GN, Destariani CP, Lubis AN, Deliana M. Thyroid hormone profile in children with sepsis: does euthyroid sick syndrome exist? Open Access Maced J Med Sci 2019;7(7):1110. [CrossRef] google scholar
- 20. den Brinker M, Joosten KF, Visser TJ, Hop WC, de Rijke YB, Hazelzet JA et al. Euthyroid sick syndrome in meningococcal sepsis: the impact of peripheral thyroid hormone metabolism and binding proteins. J Clin Endocrinol Metab 2005;90(10):5613-20. [CrossRef] google scholar
- 21. Hagag AA, El Frargy MS, Yonis RL, Al-Ashmawy GM. Diagnostic Value of Assessment of Serum Cortisol, Hepcidin and Thyroid Hormones Levels in Neonates with Late-Onset Sepsis. Infect Disord Drug Targets 2021;21(2):248-56. [CrossRef] google scholar
- 22. Arnau-Barres I, Güerri-Fernândez R, Luque S, Sorli L, Vâzquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis 2019;38(4):743-6. [CrossRef] google scholar
Abstract
Amaç: Ötiroid hasta sendromu (ÖHS), serum serbest tiroid hormonlarının
azalması ve tiroid stimülan hormonun normal veya
azalmış sekresyonu ile kendini gösterir. Bu çalışmada, sepsisli
yaşlı hastalarda ÖHS prevalansının belirlenmesi ve prognoz ve
mortalite üzerindeki olası etkisinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Sepsis tanısı alan 203 hasta prospektif olarak
değerlendirildi. Hastalar geriatrik grup (≥65 yaş) ve kontrol grubu
(<65 yaş) olarak iki gruba ayrıldı. Serbest T3 (sT3) ve/veya serbest
T4 (sT4)’ü düşük olan hastalar ötiroid hasta sendromu olduğu
kabul edildi. Hastaların demografik özellikleri, komorbiditeleri,
laboratuvar sonuçları, hastaneye yatış verileri, yoğun bakım ünitesi
(YBÜ) ihtiyacı ve kalış süreleri, tedavi sonuçları ve mortalite
oranları kaydedildi ve karşılaştırıldı.
Bulgular: Geriatrik grupta ÖHS insidansı anlamlı olarak daha
yüksekti (%88,5 vs %77,8) (p=0,04). Gruplar arasında mortalite
ve YBÜ ihtiyaçları açısından anlamlı fark saptanmadı. Bununla
birlikte, tüm hastalarda ölen hastaların oranı %91,3 ve geriatrik
gruptaki ölen hastaların ise tamamı ÖHS (+) hastalardı. Ölen
hastalarda ve YBÜ hastalarında ortalama sT3 düzeyleri anlamlı
olarak azalmıştı (p=0,017). Ek olarak, hem tüm grupta hem de
geriatrik grupta azalmış sT4 seviyeleri mortalite ve yoğun bakım
ihtiyaçları ile anlamlı olarak ilişkiliydi (p-değeri: sırasıyla 0,020 ve
0,019).
Sonuç: Sepsisli yaşlı hastalarda ÖHS prevalansının (%88,5) daha
yüksek olduğu açıkça gösterilmiştir. Ek olarak, ÖHS (+) grubunda yaklaşık iki kat daha yüksek mortalite ve YBÜ kalış riski belgelenmiştir.
Bu nedenle, sepsisi olan yaşlı hastalarda ÖHS’nin basitçe
taranması, tedavi kararlarına ve karmaşık klinik seyrin erken
tahminine ve kötü prognozun belirlenmesine kesinlikle katkıda
bulunacaktır.
References
- 1. Napolitano LM. Sepsis 2018: Definitions and guideline changes. Surgical infections 2018;19(2):117-25. [CrossRef] google scholar
- 2. Rowe TA, McKoy JM. Sepsis in older adults. Infectious Disease Clinics 2017;31(4):731-42. [CrossRef] google scholar
- 3. Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJ et al. Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection: a systematic review and meta-analysis. Annals of internal medicine 2018;168(4):266-75. [CrossRef] google scholar
- 4. Ganesan K, Wadud K. Euthyroid sick syndrome. StatPearls Publishing; 202 2 Jan-. www.ncbi.nlm.nih.gov/books/ NBK482219/ google scholar
- 5. Guo J, Hong Y, Wang Z, Li Y. Analysis of the Incidence of Euthyroid Sick Syndrome in Comprehensive Intensive Care Unit and Related Risk Factors. Front Endocrinol (Lausanne) 2021;12:656641. [CrossRef] google scholar
- 6. Polini A, Iglesias P, Dardano A, Tognini S, Castiglioni M, Diez JJ et al. Euthyroid sick syndrome and fasting hyperglycaemia in the elderly: Independent risk factors of in-hospital mortality. A prospective multicentric study. G Gerontol 2012;60(2):61-9. http://hdl.handle.net/11568/158606 google scholar
- 7. Boonmee P, Ruangsomboon O, Limsuwat C, Chakorn T. Predictors of mortality in elderly and very elderly emergency patients with Sepsis: a retrospective study. West J Emerg Med 2020;21(6):210. [CrossRef] google scholar
- 8. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE open medicine. 2019;7:2050312119835043. [CrossRef] google scholar
- 9. Cheng HH, Chen FC, Change MW, Kung CT, Cheng CY, Tsai TC, et al. Difference between elderly and non-elderly patients in using serum lactate level to predict mortality caused by sepsis in the emergency department. Medicine 2018;97(13):e0209. [CrossRef] google scholar
- 10. Preechasuk L, Suwansaksri N, Ipichart N, Vannasaeng S, Permpikul C, Sriwijitkamol A. Hyperglycemia and glycemic variability are associated with the severity of sepsis in nondiabetic subjects. J Crit Care 2017;38:319-23. [CrossRef] google scholar
- 11. Sim YS, Jung H, Shin TR, Kim DG, Park SM. Mortality and outcomes in very elderly patients 90 years of age or older admitted to the ICU. Respir Care 2015;60(3):347-55. [CrossRef] google scholar
- 12. Biyikli E, Kayipmaz AE, Kavalci C. Effect of platelet-lymphocyte ratio and lactate levels obtained on mortality with sepsis and septic shock. Am J Emerg Med 2018;36(4):647-50. [CrossRef] google scholar
- 13. Arihan O, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig J et al. Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU. PloS one 2018;13(1):e0191697. [CrossRef] google scholar
- 14. Kagansky N, Tal S, Levy S. Euthyroid sick syndrome in older people. Rev Clin Gerontol 2001;11(1):1-4. [CrossRef] google scholar
- 15. Zhu C, Zhu J, Liang Z, Kong Y, Liu Y. The correlation of metabolic syndrome with low triiodothyronine syndrome, subclinical hypothyroidism and hyperhomocysteinemia in the elderly. Chines Journal of Geriatrics 2018;37(9):988-91. [CrossRef] google scholar
- 16. Padhi R, Kabi S, Panda BN, Jagati S. Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis. International journal of critical illness and injury science 2018;8(3):165. [CrossRef] google scholar
- 17. Neamtu ML, Dobrota L, Neamtu MB, Neamtu CB, Diac FS. 966 the nonthyroidal illness syndrome in septic children. Archives of Disease in Childhood 2012;97(2):A276. [CrossRef] google scholar
- 18. Ergan B, Ergün R, Aydin K, Ergün D. Nonthyroidal illness syndrome in severe chronic obstructive pulmonary disease exacerbations in the elderley. Turkish Journal of Geriatrics/ Türk Geriatri Dergisi 2016;19(2):67-73. [CrossRef] google scholar
- 19. Yanni GN, Destariani CP, Lubis AN, Deliana M. Thyroid hormone profile in children with sepsis: does euthyroid sick syndrome exist? Open Access Maced J Med Sci 2019;7(7):1110. [CrossRef] google scholar
- 20. den Brinker M, Joosten KF, Visser TJ, Hop WC, de Rijke YB, Hazelzet JA et al. Euthyroid sick syndrome in meningococcal sepsis: the impact of peripheral thyroid hormone metabolism and binding proteins. J Clin Endocrinol Metab 2005;90(10):5613-20. [CrossRef] google scholar
- 21. Hagag AA, El Frargy MS, Yonis RL, Al-Ashmawy GM. Diagnostic Value of Assessment of Serum Cortisol, Hepcidin and Thyroid Hormones Levels in Neonates with Late-Onset Sepsis. Infect Disord Drug Targets 2021;21(2):248-56. [CrossRef] google scholar
- 22. Arnau-Barres I, Güerri-Fernândez R, Luque S, Sorli L, Vâzquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis 2019;38(4):743-6. [CrossRef] google scholar
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | RESEARCH |
| Authors | |
| Publication Date | October 28, 2022 |
| Submission Date | January 27, 2022 |
| Published in Issue | Year 2022 Volume: 85 Issue: 4 |
Cite
Contact information and address
Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE
Email: itfdergisi@istanbul.edu.tr
Phone: +90 212 414 21 61