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Increased Thyroxin During Therapeutic Hypothermia Predicts Death in Comatose Patients After Cardiac Arrest

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Abstract

Background

The course and prognostic value of pituitary-thyroid axis hormones is not well studied after cardiac arrest. We aimed to study the prognostic role of the pituitary-thyroid axis response to resuscitation from cardiac arrest before, during and after therapeutic hypothermia.

Methods

We conducted a retrospective cohort study in consecutive comatose patients after out-of-hospital cardiac arrest who were sampled before, during and up to 48 h after a 24-h period of therapeutic hypothermia in the intensive care unit (ICU). Thyroid-stimulating hormone, total and free thyroxine (T4) and triiodothyronine (T3) were determined and compared between ICU outcome groups.

Results

We included twenty-nine patients. TSH levels were comparable in non-survivors (n = 17) and survivors (n = 12). The free T4 levels were higher in non–survivors than in survivors (P = 0.001), whereas the free T3 levels were comparable. All samples’ results similarly declined in both outcome groups up to 72 h after start of 24 h hypothermia. ROC curves analyses showed a maximum AUC of 0.83 (P = 0.003) for free T4 at the end of hypothermia with an optimal cut off ≥17.8 pmol/L to obtain 100 % specificity and positive predictive value for non-survival.

Conclusion

Non-survival after cardiac arrest, coma, and therapeutic hypothermia following successful resuscitation is associated with a transient increase in free T4, most probably due to inhibition of free T4 to T3 conversion. However, before routine clinical application, external validation of our finding to assess generalizability is warranted.

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Acknowledgements

We thank the staff of participating ICU’s for help.

Conflict of interest

None of the authors have a conflict of interest.

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Authors and Affiliations

  1. Department of Intensive Care of Erasmus Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Mathieu van der Jagt & A. B. Johan Groeneveld

  2. Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    Saskia Knoops, Margriet F. C. de Jong & A. B. Johan Groeneveld

  3. Rode Kruis Ziekenhuis, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands

    Saskia Knoops

  4. Medisch Centrum Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Martin J. de Jong

  5. Department of Internal Medicine, Erasmus Medical Center, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Robin P. Peeters

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  1. Mathieu van der Jagt
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  3. Margriet F. C. de Jong
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Correspondence to Mathieu van der Jagt.

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van der Jagt, M., Knoops, S., de Jong, M.F.C. et al. Increased Thyroxin During Therapeutic Hypothermia Predicts Death in Comatose Patients After Cardiac Arrest. Neurocrit Care 23, 198–204 (2015). https://doi.org/10.1007/s12028-014-0091-8

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  • DOI: https://doi.org/10.1007/s12028-014-0091-8

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