Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases

Woo Kyung Lee, Sena Hwang, Daham Kim, Seul Gi Lee, Seonhyang Jeong, Mi Youn Seol, Hyunji Kim, Cheol Ryong Ku, Dong Yeop Shin, Woong Youn Chung, Eun Jig Lee, Jandee Lee, Young Suk Jo

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood. The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s). The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes. The enrolled patients (n=213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n=11, 5.2%), mild NTI (n=113, 53.1%), moderate NTI (n=78, 36.6%), and severe NTI (n=11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P<0.0001) and a significant positive association with LOS in the ICU (P=0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio=3.101; 95% confidence interval=1.711-5.618; P<0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P=0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P=0.016). NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.

Original languageEnglish
Article numbere3346
JournalMedicine (United States)
Volume95
Issue number14
DOIs
Publication statusPublished - 2016 Apr 1

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Critical Illness
Communicable Diseases
Intensive Care Units
Thyroid Function Tests
Length of Stay
Thyroid Gland
Mortality
Hypothalamus
C-Reactive Protein
Medical Records
Blood Proteins
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Lee, W. K., Hwang, S., Kim, D., Lee, S. G., Jeong, S., Seol, M. Y., ... Jo, Y. S. (2016). Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases. Medicine (United States), 95(14), [e3346]. https://doi.org/10.1097/MD.0000000000003346
Lee, Woo Kyung ; Hwang, Sena ; Kim, Daham ; Lee, Seul Gi ; Jeong, Seonhyang ; Seol, Mi Youn ; Kim, Hyunji ; Ku, Cheol Ryong ; Shin, Dong Yeop ; Chung, Woong Youn ; Lee, Eun Jig ; Lee, Jandee ; Jo, Young Suk. / Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases. In: Medicine (United States). 2016 ; Vol. 95, No. 14.
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title = "Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases",
abstract = "Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood. The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s). The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes. The enrolled patients (n=213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n=11, 5.2{\%}), mild NTI (n=113, 53.1{\%}), moderate NTI (n=78, 36.6{\%}), and severe NTI (n=11, 5.2{\%}). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P<0.0001) and a significant positive association with LOS in the ICU (P=0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio=3.101; 95{\%} confidence interval=1.711-5.618; P<0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P=0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P=0.016). NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.",
author = "Lee, {Woo Kyung} and Sena Hwang and Daham Kim and Lee, {Seul Gi} and Seonhyang Jeong and Seol, {Mi Youn} and Hyunji Kim and Ku, {Cheol Ryong} and Shin, {Dong Yeop} and Chung, {Woong Youn} and Lee, {Eun Jig} and Jandee Lee and Jo, {Young Suk}",
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Lee, WK, Hwang, S, Kim, D, Lee, SG, Jeong, S, Seol, MY, Kim, H, Ku, CR, Shin, DY, Chung, WY, Lee, EJ, Lee, J & Jo, YS 2016, 'Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases', Medicine (United States), vol. 95, no. 14, e3346. https://doi.org/10.1097/MD.0000000000003346

Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases. / Lee, Woo Kyung; Hwang, Sena; Kim, Daham; Lee, Seul Gi; Jeong, Seonhyang; Seol, Mi Youn; Kim, Hyunji; Ku, Cheol Ryong; Shin, Dong Yeop; Chung, Woong Youn; Lee, Eun Jig; Lee, Jandee; Jo, Young Suk.

In: Medicine (United States), Vol. 95, No. 14, e3346, 01.04.2016.

Research output: Contribution to journalArticle

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AU - Lee, Woo Kyung

AU - Hwang, Sena

AU - Kim, Daham

AU - Lee, Seul Gi

AU - Jeong, Seonhyang

AU - Seol, Mi Youn

AU - Kim, Hyunji

AU - Ku, Cheol Ryong

AU - Shin, Dong Yeop

AU - Chung, Woong Youn

AU - Lee, Eun Jig

AU - Lee, Jandee

AU - Jo, Young Suk

PY - 2016/4/1

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N2 - Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood. The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s). The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes. The enrolled patients (n=213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n=11, 5.2%), mild NTI (n=113, 53.1%), moderate NTI (n=78, 36.6%), and severe NTI (n=11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P<0.0001) and a significant positive association with LOS in the ICU (P=0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio=3.101; 95% confidence interval=1.711-5.618; P<0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P=0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P=0.016). NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.

AB - Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood. The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s). The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes. The enrolled patients (n=213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n=11, 5.2%), mild NTI (n=113, 53.1%), moderate NTI (n=78, 36.6%), and severe NTI (n=11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P<0.0001) and a significant positive association with LOS in the ICU (P=0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio=3.101; 95% confidence interval=1.711-5.618; P<0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P=0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P=0.016). NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.

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