Risk Factor Analysis Of ESS And Its Prognostic Value In General ICU

Influenced by trauma,infection,surgery,inflammation and many other factors,patients with normal basic thyroid function often present with abnormal thyroid hormone levels.This most commonly results in decreased plasma triiodothyronine(T3)or free triiodothyronine(FT3)and can also be decreased or normal thyroxine(T4)and thyroid-stimulating-hormone(TSH),and increased plasma reverse T3(RT3).These alterations in thyroid hormones are known as euthyroid sick syndrome(ESS),or low T3 syndrome.This syndrome is possibility associated with decrease of 5’-deiodinase activity caused by various factors activated by the systemic inflammatory reaction,further decrease of T4 transformed to active T3;however,the mechanism remains unclear.Some consider ESS not to be a disease itself but rather a manifestation of a self-protective mechanism in critically ill patients.Studies have shown that ESS is significantly correlated with adverse prognosis of acute myocardial infarction,heart failure,sepsis,severe trauma,and acute respiratory distress syndrome.T3 or free T3(FT3)can be considered an independent prognostic indicator in myocardial infarction and heart failure.It was also found that there was a correlation between the decrease in T3 or FT3 levels and mortality in the study of Intensive-care Unit(ICU)patients,which preliminarily indicated that T3 or FT3 had certain prognostic value.However,most of the studies are relatively shallow with a small sample size,especially the lack of in-depth studies on the prognostic value of general ICU patients.The purpose of this study was to investigate the incidence of ESS in the general ICU with related risk factors,the correlation between ESS and various factors in ICU patients,and to further investigate the independent prognostic value of ESS or FT3 level in 28-day mortality,so as to find the optimal cut-off value of FT3.Part One The incidence of ESS in general ICU and Analysis ofrelated risk factorsObjective: to study the incidence of ESS in general ICU and to analyze the associated risk factors.Methods: all eligible patients admitted to the ICU in the third hospital of hebei medical university from February 2018 to November 2018 were included in a prospective observational study.Collect clinical and various test data.ESS was defined as FT3 level below the normal laboratory value(FT3<3.28pmol/L),and the incidence of ESS in ICU patients was calculated.The included patients were divided into ESS group and non-ess group,clinical data were compared between the two groups,and various risk factors that may be related to ESS were screened by logistic regression analysis.Results:1.The incidence of ESS in the general ICU was38.7%(32.8%～44.6%).2.Acute physiology and dhronic health evaluation II score(APACHE II),sequential organ failure score(SOFA),brain natriuretic peptide(BNP),activated partial thromboplastin time(APTT),hemoglobin(HGB),platelet(PLT),creatinine(CREA),albumin(ALB),free thyroxine(FT4),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were significantly correlated with ESS,which were risk factors for ESS and odds ratio.OR)were 1.074,1.143,1.001,1.017,1.003,0.98,0.997,0.929,0.864,0.992,0.985,respectively.3.BNP,PLT and ALB were independent risk factors for ESS,with OR values of 1.001,0.994 and 0.931,respectively.Conclusions:1.The incidence of ESS in the comprehensive ICU was 38.7%(32.8%～44.6%).2.APACHE II,SOFA,BNP,APTT,HGB,PLT,CREA,ALB,FT4,SBP and DBP were risk factors for ESS.BNP,PLT and ALB were independent risk factors for ESS.Part Two A study on the prognosis of ESS patients in general ICUObjective: to study the relationship between ESS and prognosis in general ICU patients.Methods: this study included 118 ESS and 187 non-ess patients.Clinical data collection as part one.Prognostic indicators such as 28-day mortality rate,mechanical ventilation utilization rate,mechanical ventilation duration,length of stay in ICU and cost of stay in ICU were compared between the two groups.Results:1.The incidence of ESS in the death group was 65.7%,significantly higher than that in the survival group.The FT3 level of the death group was3.07±0.92pmol/L,and the FT3 level of the survival group was3.54±0.79pmol/L(P=0.001).2.The 28-day mortality rate at ESS was 19.5%,significantly higher than that of the non-ess group at 6.4%(P<0.001),ESS was the prognostic index of28-day mortality in comprehensive ICU patients.3.There was no statistical difference between the two groups in terms of mechanical ventilation and length of stay in ICU.4.The median hospitalization cost of the ESS group was RMB 45,700,significantly higher than that of the non-ess group,which was RMB 33,500(P=0.001).Conclusions:ESS is closely related to the prognosis of general ICU patients.Part Three The independent predictive value of FT3 in 28-day death of ESS patients in ICUObjective: to study the independent prognostic value of ESS on 28-day mortality rate and the cut-off value of FT3 in general ICU patients.Methods: this study included 118 ESS and 187 non-ess patients,of whom 35 died and 270 survived.The clinical data collection is the same as the first part,and the follow-up part is the same as the second part.SPSS24.0statistical software was used to carry out a single factor regression analysis of28-day mortality rate and each correlation variable one by one,and to find out each correlation variable of 28 d mortality.All variables and FT3 or ESS were included in the multivariate logistic regression equation for multivariate regression analysis.The correlation between FT3 and APACHEII score was analyzed.The receiver operating characteristic curve(ROC curve)was used to evaluate FT3 and 28-day mortality rate,and the cut-off value of FT3 and its corresponding sensitivity and specificity were found.Results:1.FT3 was an independent prognostic index of 28-day mortality in ICU patients,with an OR value of 20.26.2.FT3 was correlated with the scores of APACHEII and SOFA,and the correlation coefficients were-0.262 and-0.263,respectively.3.The AUC value of FT3 and 28-day mortality ROC curve was0.671±0.055,and the cut-off value of FT3 was 2.88pmol/L,corresponding sensitivity was 51.4% and specificity was 81.5%.Conclusion:1.FT3 is an independent prognostic indicator of 28-day mortality in general ICU patients.2.FT3 has high specificity in predicting 28-day mortality and has clinical application value.