Study On Endocrine System In Critically Ill Patients

PrefaceWhen patients suffer operation , trauma , severe infection, they will undergo organ dysfunction in lung , cardiovascular system , lung , gastrointestinal system and endocrinal system. The physiology will be out of balance and a series of related changes in metabolism, nutrition and immune will happen. So we collected some patients' data to investigate the profile of changes in blood glucose , thyroid function and cortisol which occurring under critical illness and to explore the interrelation of these endocrine factors in order to direct clinical therapy.Material and Methods1. Study populationThe patients hospitalized in ICU of the 1^st affiliated hospital of China Medical University from November, 2004 to March, 2005 were studied. The patients whose APACHE-â…¡ score was much more than 8 were studied. The eliminating standards: less than 18 years old; suffering from thyroid diseases or other endocrinal diseases; treated with glucocorticoid for a long time: pregnancy. A total of 24 patients with critical illness were studied in this prospective clinical study, either with multiple organ dysfunction syndrome (MODS, n=12) or without MODS (n=7) except 5 dead patients.2. Study itemsSerum thyroid hormone , TSH and cortisol concentrations were measured in 24 patients of intensive care unit(ICU) in the first day by Chemiluminescent Microparticle Immunoassay(CMIA),except five patients of death in two days after hospitalization in ICU, continuing to measure the blood sample of other 19 patients in the third day. Patients' age, bloodglucose and APACHE-II score were recorded at first ICU day.Results1. The rate of thyroid hormone and cortisol abnormalityIn the alive 19 patients, FT3 decreased in 16 patients(84%), TSH level decreased in 10 patients(53%) and COR level increased in 15 patients(79%). In the dead 5 patients, FT3 decreased in all of them and COR increased obviously, FT4 decreased apparently in 3 patients, at the same time, TSH decreased, too.2. Hormone changes in alive patients 2.1 Glucose changesGlucose level increased in all the 24 patients, yet in the alive 19 patients, the level of MODS group was higher than non-MODS group, PO.05. 2.2Thyroid hormone and TSH changesIn the alive 19 patients, FT3 was much lower than normal in the first 24 hours, P<0.01; the level of TSH decreased obviously, too, P<0.05. In different courses of the disease, FT3 was much lower in MODS than in non-MODS, PO.01, and TSH was lower than non-MODS, but there was no statistical differences. The value of the index was slightly increased in the third day, but FT3 was still lower than normal, P<0.01. 2.3Cortisol changesIn the alive 19 patients, cortisol increased obviously, especially in the first 24 hours, and decreased slightly in the third day, P<0.01. Cortisol was higher in MODS group than non-MODS group, PO.01.3. Hormone differences between alive group and dead groupThere were 5 patients who died in the first two days, the level of glucose and cortisol increased obviously, and FT4 decreased apparently. The value was highly significant when compared with alive patients, P<0.01. FT3 and TSH decreased obviously, too, P<0.05.4. The relationship between thyroid hormone, cortisol and disease severityThyroid hormone changes were highly related with disease severity. FT3...