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Thyroid hormone disorders: a predictor of mortality in patients with septic shock defined by Sepsis-3?

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Abstract

Decreased serum thyroid hormone levels and their prediction of mortality in septic patients are still controversial, especially with the evolution of the definition of sepsis. This study aimed to assess the ability of thyroid hormone disorders to predict the early mortality of patients with septic shock defined by Sepsis-3. Sixty-three adult patients with septic shock admitted to a university hospital emergency intensive care unit (EICU) were studied. Serum free T3 (FT3), free T4 (FT4), thyroid stimulating hormone (TSH), C-reactive protein (CRP), procalcitonin (PCT), and lactate levels were determined and compared with survival status and organ dysfunction. Among the 63 patients studied, lower serum FT3 and FT4 levels were significantly associated with higher sequential organ failure assessment (SOFA) scores. Patients with septic shock with lower levels of FT3 (≤ 1.70 pmol/L) and FT4 (≤ 9.99 pmol/L) had significantly increased 28-day mortality. There was no significant difference in the serum TSH level between the survivor and nonsurvivor groups. The areas under the receiver operating characteristic curves for FT3 and FT4 levels were associated with 28-day mortality (0.92 and 0.89, respectively) and were higher than that for SOFA (0.82), CRP (0.65) and lactate (0.59). The decrease in serum levels of FT3 and FT4 in patients with septic shock is associated with the severity of organ dysfunction and 28-day mortality. Early detection of serum FT3 and FT4 levels could help clinicians to identify patients at high risk of clinical deterioration.

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Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

CRP:

C-reactive protein

DCs:

Dendritic cells

EICU:

Emergency intensive care unit

ESS:

Euthyroid sick syndrome

NPV:

Negative predictive value

NTIS:

Nonthyroidal illness syndrome

PCT:

Procalcitonin

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

SOFA:

Sequential organ failure assessment

TSH:

Thyroid stimulating hormone

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Acknowledgments

We thank Pro. Shu-Zhang Cui of Emergency Department of Tianjin Medical University General Hospital for the guidance in designing this work.

Funding

This work was supported by the National Natural Science Foundation of China (No. 81601714, 81871593).

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Author notes

  1. Yan-Cun Liu, Tian-Yu Jiang and Zhen-Sen Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People’s Republic of China

    Yan-Cun Liu, Tian-Yu Jiang, Zhen-Sen Chen, An-Long Qi, Yu-Lei Gao, Shi-Xin Li, Mu-Ming Yu, Yan-Fen Chai & Song-Tao Shou

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Contributions

This study was designed by STS, YFC. YCL contributed to the design of the study and written the manuscript. TYJ and ALQ collected and analyzed the data, ZSC provided great help to the revision of the article, YLG contributed to the statistical analysis, SXL and MMY helped collect data. All authors participated in the review and revision of the paper. All authors read and approved the final manuscript.

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Correspondence to Yan-Cun Liu or Song-Tao Shou.

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The authors declare they have no conflict of interest.

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The protocol of the study was approved by the institutional medical research review board of Tianjin Medical University General Hospital, Tianjin, China.

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Liu, YC., Jiang, TY., Chen, ZS. et al. Thyroid hormone disorders: a predictor of mortality in patients with septic shock defined by Sepsis-3?. Intern Emerg Med 16, 967–973 (2021). https://doi.org/10.1007/s11739-020-02546-2

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