TY - JOUR
T1 - Distinct Features of Nonthyroidal Illness in Critically Ill Patients with Infectious Diseases
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
N1 - Funding Information:
This study was supported by National Research Foundation of Korea (NRF) grants funded by the Korean government (MEST) (2014R1A1A2059343).
Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016/4/1
Y1 - 2016/4/1
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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U2 - 10.1097/MD.0000000000003346
DO - 10.1097/MD.0000000000003346
M3 - Article
C2 - 27057916
AN - SCOPUS:84964661079
SN - 0025-7974
VL - 95
JO - Medicine (United States)
JF - Medicine (United States)
IS - 14
M1 - e3346
ER -