Effect Of Enteral Nutrition On Thyroid Function In Patients With Nonthyroidal Illness Syndrome

?Background?Intestinal fistula is one of various forms of the gastrointestinal fistulas,a severe complication resulting mostly from trauma or surgical procedures,which is frequently accompanied with long disease course,substantial costs,and significant mortality.Evidences from recent studies demonstrated that patients suffering from intestinal fistula had disorders in multiple endocrinal organs including thyroid gland,other than conventional intra-abdominal infection and fluid and electrolyte imbalance.It has been reported that the incidence of Nonthyroidal Illness Syndrome(NTIS)is relatively high among patients with intestinal fistula.This syndrome is characterized by alterations in thyroid function,commonly presented as low serum triiodothyronine(T3)and normal to low thyroxine(T4).Studies have suggested that a low level of T3 is an independent preditor of poor outcomes in sepsis and critical illness patients.Similar correlation exists between NTIS and the outcomes of patients with intestinal fistula,suggesting the clinical implication of thyroid function alterations in intestinal fistula.Thus far the pathogenesis of NTIS in intestinal fistula remains largely unknown.Whether and how to intervene clinically is also controversial.Some researches manifested the association of malnutrition and NTIS,implying the possible effects of enteral nutrition in NTIS when improving the nutritional status.However there are also opposite opinions that enteral nutrition may not be able to improve the thyroid function since NTIS does not result from malnutriton.Therefore to clarify whether enteral nutrion may help alleviate the NTIS complicating intestinal fistula,we conducted a retrospective observational study,aiming to explore the role of enteral nutrition in the thyroid function of NTIS.?Objectives?To ascertain the ameliorative effect of enteral nutrition on the levels of thyroid hormones in intestinal fistula patients with NTIS by observation and statistical analysis of the kenetics of thyroid hormones and primary diseases during hospitalization in this retrospective observational study.?Methods?Consecutive patients with intestinal fistula and NTIS in Jinling hospital were retrospectively screened and enrolled between Jan 2013 and Apr 2014.The observational cohort was tracked for 4 weeks,and then divided into two groups,namely the remission group and unremission group,according the conditions of NTIS.In addition,patients were also divided into early nutriton group and delayed nutrition group based on the time of enteral nutrion initiation.Those achieving full dose nutrition within the first two weeks belonged to the early nutrition group,and others to the delayed nutrition group.?Results?1.80 patients with intestinal fistula and NTIS were included.After treatment of enteral nutrition,66 patients had NTIS relieved,making the total effective rate of 82.5%.The multivariate cox proportional hazard model indicated that the interval between admission and initiation of full dose nutrition was an independent factor of remission in NTIS.2.Division of the patients based on the time of enteral nutrion initiation found that the rates of treatment success in early nutrition and delayed nutrition groups were 92% and66.67% respectively,and the difference reached statistical significance(?2 =4.167,P=0.04).?Conclusions?Our study demonstrated the efficacy of enteral nutrition in improving the thyroid function among patients with intestinal fistula and NTIS.Early initiation and achievement of full dose nutrition is an independent factor of remission in NTIS.Besides,the role of enteral nutrition in intestinal fistula has also ben further confirmed.