A new marker in determining the relationship between the clinical outcomes of patients with sepsis and thyroid function tests: free triiodothyronine to free thyroxine ratio

Esra Yakışık; Çiğdem Yücel; Murat Kızılgün; Işıl Özkoçak Turan

doi:10.17826/cumj.1310083

EN TR

A new marker in determining the relationship between the clinical outcomes of patients with sepsis and thyroid function tests: free triiodothyronine to free thyroxine ratio

Abstract

Purpose: This study investigated the predictive value of thyroid hormones in septic patients. Materials and Methods: Our study was conducted in patients with sepsis in intensive care unit (ICU). Free triiodothyronine (fT3) and free thyroxine (fT4) levels taken at the time of hospitalization and at the 48th hours were measured and the fT3 / fT4 ratio was calculated. Calculated fT3 and fT4 change between first and 48th hours. Results: 192 patients with sepsis were included in the study. In non-survivor patients, first fT3 (1.60±0.57 ng/dL v.s. 2.01±0.41 ng/dL) and fT3 / fT4 ratio (1.34±0.88 v.s. 1.79±0.91) were found to be significantly lower than 48th hours fT3 (0.77±0.39 ng/dL v.s. 1.87±0.49 ng/dL) and fT3 / fT4 ratio (0.60±0.51 v.s. 1.66±1.21) survivors. It was found that the first fT3 levels (-0.83±0.45 v.s. -0.23±0.14) and fT3 / fT4 ratio (-0.73±0.62 v.s. -0.12±0.11) decreased significantly more at 48th hour in non-survivors than survivors. The 48th hours fT3 level and the change in fT3 between the first and 48th hour were found to be the most significant parameters for the mortality indicator. Conclusion: fT3 / fT4 ratio has predictive value for mortality in patients with sepsis in ICU. In addition, fT3 was found to be an indicator for mortality predictivity both at admission and at 48th hours.

Keywords

Free triiodothyronine/free thyroxine ratio , Intensive care unit , Sepsis , Thyroxine , Triiodothyronine

Sepsis hastalarının klinik sonuçları ile tiroid fonksiyon testleri arasındaki ilişkinin belirlenmesinde yeni bir belirteç: serbest triiyodotironinin serbest tiroksin oranı

Öz

Amaç: Çalışmamızda septik hastalarda tiroid hormonlarının prediktif değerini araştırdık. Gereç ve Yöntem: Çalışmamız yoğun bakım ünitesinde (YBÜ) yatan sepsis hastalarında yapıldı. Hastaneye yatış anında ve 48. saatte alınan serbest triiodotironin (sT3) ve serbest tiroksin (sT4) düzeyleri ölçüldü ve sT3/sT4 oranı hesaplandı. Birinci ve 48. saatler arasındaki sT3 ve sT4, değişikliği hesaplandı. Bulgular: Çalışmaya 192 sepsis hastası dahil edildi. Kaybedilen hastalarda birinci sT3 (1.60±0.57 ng/dL vs 2.01±0.41 ng/dL) ve sT3/sT4 oranı (1.34±0.88 vs 1.79±0.91), 48. saatteki sT3 (0.77±0.39 ng/dL vs 1.87±0.49 ng/dL) ve sT3/sT4 oranından (0.60±0.51 vs 1.66±1.21) yaşayanlara göre anlamlı olarak düşük bulundu. İlk sT3 düzeylerinin (-0.83±0.45 vs -0.23±0.14) ve sT3/sT4 oranının 48. saatte (-0.73±0.62 vs -0.12±0.11) kaybedilenlerde yaşayanlarda göre anlamlı olarak daha fazla azaldığı saptandı. 48. saat sT3 düzeyi ve ilk ile 48. saat arasındaki sT3 değişiminin mortalite göstergesi için en anlamlı parametreler olduğu bulundu. Sonuç: sT3/sT4 oranının YBÜ’deki sepsisli hastalarda mortalite için prediktif değere sahip olduğu gösterilmiştir. Ayrıca hem yatışta hem de 48. saatteki sT3 değerleri mortalite için anlamlı öngörücü göstergeler olduğu bulundu.

Anahtar Kelimeler

Serbest triiyodotironin/serbest tiroksin oranı , Yoğun bakım ünitesi , Sepsis , Tiroksin , Triiyodotironin

Kaynakça

Widmer A, Schuetz P. Endocrine dysfunction during sepsis are changes in hormone levels a physiological adaptation or a therapeutic target? J Lab Precis Med. 2018;3:61.
Çakır U, Tayman C. The effect of thyroid functions on osteopenia of prematurity in preterm infants. J Pediatr Endocrinol Metab. 2019;32:65-70.
Kim JG, Shin H, Kim W, Lim TH, Jang B, Cho Y et al. The value of decreased thyroid hormone for predicting mortality in adult septic patients: A systematic review and meta-analysis. Sci Rep. 2018;8:14137.
Park SY, Park SE, Jung SW, Jin HS, Park IB, Ahn SV et al. Free triiodothyronine/free thyroxine ratio rather than thyrotropin is more associated with metabolic parameters in healthy euthyroid adult subjects. Clin Endocrinol (Oxf). 2017;87:87-96.
Corona G, Solaroli E, Tortorici G, Sforza A. Heart and thyroid interactions. G Ital Cardiol (Rome). 2019;20:342-50.
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;7:1110-3.
Dai JJ, Du DF, Ma G, Jiang MJ. Association between serum-free thyroxine level and all-cause mortality in critically ill patients: a retrospective study from MIMIC-IV. Front Endocrinol (Lausanne). 2023;14:1164369.
Patel D, Naik D, Kamalanathan S, Tamilarasu K, Sahoo J, Roy A et al. Thyroid function abnormalities and outcomes in hospitalized patients with COVID-19 infection: A cross-sectional study. Horm Metab Res. 2023;55:169-75.
Lodha R, Vivekanandhan S, Sarthi M, Arun S, Kabra SK. Thyroid function in children with sepsis and septic shock. Acta Paediatr. 2007;96:406-9.
Ray DC, Drummond GB, Wilkinson E, Beckett GJ. Relationship of admission thyroid function tests to outcome in critical illness. Anaesthesia. 1995;50:1022-5.

Baral S, Shrestha PK, Pant V. Serum Free T3 to Free T4 ratio as a useful indicator for differentiating destruction induced thyrotoxicosis from Graves' Disease. J Clin Diagn Res. 2017;11:OC12-OC14.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-10.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45:486-552.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med. 1996;22:707-10.
Akobeng AK. Understanding diagnostic tests 3: Receiver operating characteristic curves. Acta Paediatr. 2007;96:644-7.
Padhi R, Kabi S, Panda BN, Jagati S. Prognostic significance of nonthyroidal illness syndrome in critically ill adult patients with sepsis. Int J Crit Illn Inj Sci. 2018;8:165-72.
Wang F, Pan W, Wang H, Wang S, Pan S, Ge J. Relationship between thyroid function and ICU mortality: a prospective observation study. Crit Care. 2012;16:R11.
Qari FA. Thyroid function status and its impact on clinical outcome in patients admitted to critical care. Pak J Med Sci. 2015;31:915-9.
Bassols J, Prats-Puig A, Soriano-Rodríguez P, García-González MM, Reid J, Martínez-Pascual M, Mateos-Comerón F et al. Lower free thyroxin associates with a less favorable metabolic phenotype in healthy pregnant women. J Clin Endocrinol Metab. 2011;96:3717-23.
Krug N, Bercker S, Busch T, Friese S, Jahn N, Voelker MT. Non-thyroidal illness syndrome (NTIS) is no independent predictor for mortality in ICU patients. BMC Anesthesiol. 2023;23:103.
Mortoglou A, Candiloros H. The serum triiodothyronine to thyroxine (T3/T4) ratio in various thyroid disorders and after Levothyroxine replacement therapy. Hormones (Athens). 2004;3:120-6.
Laurberg P. Mechanisms governing the relative proportions of thyroxine and 3,5,3'-triiodothyronine in thyroid secretion. Metabolism. 1984;33:379-92.
Moura Neto A, Zantut-Wittmann DE. Abnormalities of thyroid hormone metabolism during systemic illness: The low T3 syndrome in different clinical settings. Int J Endocrinol. 2016;2016:2157583.
Arosio B, Monti D, Mari D, Passarino G, Ostan R, Ferri E et al. Thyroid hormones and frailty in persons experiencing extreme longevity. Exp Gerontol. 2020;138:111000.
Wang C, Han S, Li Y, Tong F, Li Z, Sun Z. Value of FT3/FT4 ratio in prognosis of patients with heart failure: A propensity-matched study. Front Cardiovasc Med. 2022;9:859608.
Lang X, Li Y, Zhang D, Zhang Y, Wu N, Zhang Y. FT3/FT4 ratio is correlated with all-cause mortality, cardiovascular mortality, and cardiovascular disease risk: NHANES 2007-2012. Front Endocrinol (Lausanne). 2022;13:964822.
Pasqualetti G, Schirripa M, Dochy E, Fassan M, Ziranu P, Puzzoni M et al. Thyroid hormones ratio is a major prognostic marker in advanced metastatic colorectal cancer: Results from the phase III randomised CORRECT trial. Eur J Cancer. 2020;133:66-73.
Majos A, Sewerynek E, Grząsiak O, Ciesielski W, Hogendorf P, Hołyński J et al. FT3 to FT4 conversion ratio may be an independent prognostic factor in pancreatic cancer patients. Biomedicines. 2022;11:77.
Wang Y, Sun F, Hong G, Lu Z. Thyroid hormone levels as a predictor marker predict the prognosis of patients with sepsis. Am J Emerg Med. 2021;45:42-7

Ayrıntılar

Birincil Dil

İngilizce

Konular

Yoğun Bakım

Bölüm

Araştırma Makalesi

Yazarlar

Esra Yakışık ^*
0000-0002-6992-5744
Türkiye

Çiğdem Yücel
0000-0001-9287-356X
Türkiye

Murat Kızılgün
0000-0001-5551-4058
Türkiye

Işıl Özkoçak Turan
0000-0002-0405-0107
Türkiye

Erken Görünüm Tarihi

26 Eylül 2023

Yayımlanma Tarihi

30 Eylül 2023

Gönderilme Tarihi

5 Haziran 2023

Kabul Tarihi

8 Eylül 2023

Yayımlandığı Sayı

Yıl 2023 Cilt: 48 Sayı: 3

DOI

https://doi.org/10.17826/cumj.1310083

IZ

https://izlik.org/JA95GK45FU

MLA

Yakışık, Esra, vd. “A new marker in determining the relationship between the clinical outcomes of patients with sepsis and thyroid function tests: free triiodothyronine to free thyroxine ratio”. Cukurova Medical Journal, c. 48, sy 3, Eylül 2023, ss. 1106-14, doi:10.17826/cumj.1310083.

Cited By

A novel useful marker in the early discrimination of transient hyperthyrotropinemia/hypothyroxinemia and congenital hypothyroidism in preterm infants: thyroid-stimulating hormone/free thyroxine ratio

Journal of Pediatric Endocrinology and Metabolism

https://doi.org/10.1515/jpem-2024-0118

Bu eser Creative Commons Atıf-Gayriticari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.

A new marker in determining the relationship between the clinical outcomes of patients with sepsis and thyroid function tests: free triiodothyronine to free thyroxine ratio

Abstract

Keywords

Sepsis hastalarının klinik sonuçları ile tiroid fonksiyon testleri arasındaki ilişkinin belirlenmesinde yeni bir belirteç: serbest triiyodotironinin serbest tiroksin oranı

Öz

Anahtar Kelimeler

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Erken Görünüm Tarihi

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

DOI

IZ

Kaynak Göster

Cited By

A novel useful marker in the early discrimination of transient hyperthyrotropinemia/hypothyroxinemia and congenital hypothyroidism in preterm infants: thyroid-stimulating hormone/free thyroxine ratio