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Biochemical indicators of euthyroid sick syndrome in critically ill children

  • Tolga Besci ORCID logo , Özge Besci ORCID logo , Gazi Arslan , Hande Ilgaz , Pınar Prencuva , Göktuğ Özdemir , Ayhan Abacı and Korcan Demir ORCID logo EMAIL logo
Published/Copyright: September 16, 2022
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 35 Issue 10

Abstract

Objectives

This study aimed to determine the prevalence and predictors of euthyroid sick syndrome (ESS) in pediatric intensive care, and to establish a link between thyroid function tests and mortality.

Methods

Between January 2015 and March 2020, children admitted to our pediatric intensive care unit (PICU) and tested for free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) levels were included. Patients with decreased fT3, with normal or decreased fT4, and normal or decreased TSH levels were assigned to the ESS group. The association between biochemical indicators and ESS, as well as the relationship between fT3 and mortality, were examined.

Results

A total of 141 (36%) of 386 children included to study were classified in the ESS group. The ESS group had a higher rate of 28-day mortality (12 [8.5%] vs. 9 [3.7%]). Blood urea nitrogen (BUN), albumin, platelet, lactate, and pediatric index of mortality 3 [PIM3 (%)] were significantly associated with ESS (odds ratios in order: 1.024, 0.422, 0.729, 1.208, 1.013). Multivariate regression analysis showed that BUN, albumin, platelet, and lactate were independently associated with ESS progression. The area under curve (AUC [95%CI]) for fT3 was 0.644 (0.555–0.789) to detect mortality. Children with a fT3 level lower than 2.31 pg/mL had significantly higher 28-day mortality (log rank test, p=0.001).

Conclusions

Our study identified BUN, albumin, lactate, and platelet count as independent risk factors for ESS progression in children. Furthermore, our findings indicated a correlation between fT3 and mortality, which makes fT3 an ideal candidate to be included in mortality indices.

Keywords: intensive care unit statistics; non-thyroidal illness; PRISM; reverse T3; survival rate
Corresponding author: Korcan Demir, MD, Department of Pediatric Endocrinology, Dokuz Eylul University School of Medicine, Balçova, 35340, Izmir, Turkey, Phone: +905055252743, Fax: +902324126000, E-mail:

Acknowledgments

We’d want to express our gratitude to our late mentor, Professor Dr. Tolga F. Koroglu (1968–2019). He was the chief attending physician of the PICU until September 2019, and he made this study possible by never giving up on working for his patients.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Concept: T.B., G.A., K.D., Design: T.B., Ö.B., A.A. Data Collection: T.B., G.O., H.I., P.P. Data Analysis: T.B., Ö.B., K.D., A.A., Literature Search: T.B., Ö.B., G.A., Writing, and Editing T.B., Ö.B., G.A., A.A, K.D.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The research related to human use complied with all relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the ethics committee of the Dokuz Eylul University Faculty of Medicine (5837-GOA-2020/28-01).

  6. Data availability: Data are available upon reasonable request made to corresponding author.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2022-0232).

Received: 2022-04-26
Accepted: 2022-08-29
Published Online: 2022-09-16
Published in Print: 2022-10-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

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https://doi.org/10.1515/jpem-2022-0232
Keywords for this article
intensive care unit statistics; non-thyroidal illness; PRISM; reverse T3; survival rate

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Newborn screening for propionic, methylmalonic acidemia and vitamin B12 deficiency. Analysis of 588,793 newborns
  4. Use of letrozole to augment height outcome in pubertal boys: a retrospective chart review
  5. Study of the frequency and clinical features of maturity-onset diabetes in the young in the pediatric and adolescent diabetes population in Iran
  6. Iatrogenic hyperthyroidism in primary congenital hypothyroidism: prevalence and predictive factors
  7. Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA
  8. Newborn screening and genetic variation of medium chain acyl-CoA dehydrogenase deficiency in the Chinese population
  9. Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study
  10. Effects and dose-response relationship of exercise training on cardiometabolic risk factors in children with obesity
  11. Biochemical indicators of euthyroid sick syndrome in critically ill children
  12. Short Communication
  13. Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes
  14. Case Reports
  15. Late onset Bartter syndrome: Bartter syndrome type 2 presenting with isolated nephrocalcinosis and high parathyroid hormone levels mimicking primary hyperparathyroidism
  16. Three pediatric cases of symptomatic hyponatremia in Prader–Willi syndrome
  17. Identification of a novel mutation in FGFR1 gene in mother and daughter with Kallmann syndrome
  18. Exaggerated mini-puberty in a preterm girl: a case report and review of literature
  19. Diabetic ketoacidosis masquerading behind alkalemia an undiagnosed or missed variant of diabetic ketoacidosis
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