EUTHYROID SICK SYNDROME: PREVALENCE AND PROGNOSIS IN ELDERLY PATIENTS WITH SEPSIS

Year 2022, Volume: 85 Issue: 4, 477 - 484, 28.10.2022

Ramazan Çakmak , Adem Atıcı , Murat Bektaş , Timur Akpınar , Murat Kose , Gülden Yürüyen , Oğuz Kağan Bakkaloğlu , Tufan Tükek

https://doi.org/10.26650/IUITFD.1062921

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. 

Keywords

sepsis, euthyroid sick syndrome, thyroid hormones

ÖTİROİD HASTA SENDROMU: SEPSİSLİ YAŞLI HASTALARDA SIKLIĞI VE PROGNOZU

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. 

Keywords

sepsis, ötiroid hasta sendromu, tiroid hormonları

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