Endocrine measurements in survivors and non-survivors from critical illness

Intensive Care Med. 2002 Sep;28(9):1301-8. doi: 10.1007/s00134-002-1427-y. Epub 2002 Aug 9.

Abstract

Objective: To compare measurements of thyroid and adrenal function between survivors and non-survivors in critical illness.

Design and setting: Prospective, observational study at the medical/surgical intensive care unit (ICU) at Royal Infirmary of Edinburgh, Scotland.

Patients: 163 patients admitted to the intensive care unit over a 4-month period.

Interventions: We took blood samples within 1 h of ICU admission, and at 08:00 hours on the subsequent 2 days of ICU admission. We measured serum total (TT(4)) and free (fT(4)) thyroxine, total (TT(3)) and free (fT(3)) tri-iodothyronine, thyrotropin (TSH) and plasma cortisol concentrations.

Measurements and results: TT(3) and TT(4) concentrations were significantly less in non-survivors than in survivors on admission and on day 1 but not on day 2. Cortisol concentrations were higher in non-survivors on admission and on day 1 but not on day 2. TSH, fT(3) and fT(4) concentrations did not differ significantly between survivors and non-survivors at any time. Only TT(4) and cortisol were independent predictors of outcome. Prediction of outcome from the admission sample values was not better than using APACHE II scoring.

Conclusions: Thyroid hormone and cortisol concentrations differ between survivors and non-survivors on admission to intensive care, but the values overlap. These differences do not allow accurate prediction of outcome from critical illness.

Publication types

  • Comparative Study

MeSH terms

  • APACHE
  • Adrenal Glands / physiopathology*
  • Adult
  • Aged
  • Critical Illness / mortality*
  • Dopamine / administration & dosage
  • Female
  • Glucocorticoids / administration & dosage
  • Humans
  • Hydrocortisone / blood
  • Intensive Care Units
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Scotland
  • Survivors
  • Thyroid Gland / physiopathology*
  • Thyroid Hormones / blood
  • Thyrotropin / blood

Substances

  • Glucocorticoids
  • Thyroid Hormones
  • Thyrotropin
  • Dopamine
  • Hydrocortisone