Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases
Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this st...
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| Veröffentlicht in: | Medicine (Baltimore) 2016-04, Vol.95 (14), p.e3346-e3346 |
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| creator | Lee, Woo Kyung Hwang, Sena Kim, Daham Lee, Seul Gi Jeong, Seonhyang Seol, Mi-Youn Kim, Hyunji Ku, Cheol Ryong Shin, Dong Yeop Chung, Woong Youn Lee, Eun Jig Lee, Jandee Jo, Young Suk |
| description | Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s).The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes.The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P |
| doi_str_mv | 10.1097/MD.0000000000003346 |
| format | Article |
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However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s).The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes.The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P < 0.0001) and a significant positive association with LOS in the ICU (P = 0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio = 3.101; 95% confidence interval = 1.711-5.618; P < 0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P = 0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P = 0.016).NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.</description><identifier>ISSN: 0025-7974</identifier><identifier>EISSN: 1536-5964</identifier><identifier>DOI: 10.1097/MD.0000000000003346</identifier><identifier>PMID: 27057916</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Aged ; Critical Illness ; Female ; Humans ; Infections - complications ; Inflammation - complications ; Male ; Middle Aged ; Observational Study ; Retrospective Studies ; Severity of Illness Index ; Thyroid Gland</subject><ispartof>Medicine (Baltimore), 2016-04, Vol.95 (14), p.e3346-e3346</ispartof><rights>Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4502-2f517defc323ef3d15745768e813df615f213cfe647b2af85c33621ba33eb2a3</citedby><cites>FETCH-LOGICAL-c4502-2f517defc323ef3d15745768e813df615f213cfe647b2af85c33621ba33eb2a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998832/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998832/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27057916$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Woo Kyung</creatorcontrib><creatorcontrib>Hwang, Sena</creatorcontrib><creatorcontrib>Kim, Daham</creatorcontrib><creatorcontrib>Lee, Seul Gi</creatorcontrib><creatorcontrib>Jeong, Seonhyang</creatorcontrib><creatorcontrib>Seol, Mi-Youn</creatorcontrib><creatorcontrib>Kim, Hyunji</creatorcontrib><creatorcontrib>Ku, Cheol Ryong</creatorcontrib><creatorcontrib>Shin, Dong Yeop</creatorcontrib><creatorcontrib>Chung, Woong Youn</creatorcontrib><creatorcontrib>Lee, Eun Jig</creatorcontrib><creatorcontrib>Lee, Jandee</creatorcontrib><creatorcontrib>Jo, Young Suk</creatorcontrib><title>Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases</title><title>Medicine (Baltimore)</title><addtitle>Medicine (Baltimore)</addtitle><description>Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s).The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes.The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P < 0.0001) and a significant positive association with LOS in the ICU (P = 0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio = 3.101; 95% confidence interval = 1.711-5.618; P < 0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P = 0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P = 0.016).NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.</description><subject>Aged</subject><subject>Critical Illness</subject><subject>Female</subject><subject>Humans</subject><subject>Infections - complications</subject><subject>Inflammation - complications</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observational Study</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Thyroid Gland</subject><issn>0025-7974</issn><issn>1536-5964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU9vEzEQxS0EoiH0EyAhH7ls8d_17gUJJS1EamkPlThVluMdswZnXWwvVb49LilVwRdLb37zZuyH0BtKTijp1fuL9Ql5cjgX7TO0oJK3jexb8RwtCGGyUb0SR-hVzt8JoVwx8RIdMUWk6mm7QDdrn4ufbMFnYMqcIOPo8Jc4lXGfoh9MwJsQJsgZ-wmvki_emhD29yq-MsXDVDL-6suIN5MDW3ycM66mYDLk1-iFMyHD8cO9RNdnp9erz8355afN6uN5Y4UkrGFOUjWAs5xxcHygUgmp2g46ygfXUukY5dZBK9SWGddJy3nL6NZwDlXgS_ThYHs7b3cw2LpTMkHfJr8zaa-j8frfyuRH_S3-0qLvu64OXaJ3DwYp_pwhF73z2UIIZoL6Hk2V6jvVdYJXlB9Qm2LOCdzjGEr0fS76Yq3_z6V2vX264WPP3yAqIA7AXQwFUv4R5jtIegQTyvjHr3L1pwhtiSCSNFXpGf8NUfuZvA</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Lee, Woo Kyung</creator><creator>Hwang, Sena</creator><creator>Kim, Daham</creator><creator>Lee, Seul Gi</creator><creator>Jeong, Seonhyang</creator><creator>Seol, Mi-Youn</creator><creator>Kim, Hyunji</creator><creator>Ku, Cheol Ryong</creator><creator>Shin, Dong Yeop</creator><creator>Chung, Woong Youn</creator><creator>Lee, Eun Jig</creator><creator>Lee, Jandee</creator><creator>Jo, Young Suk</creator><general>Wolters Kluwer Health, Inc. All rights reserved</general><general>Wolters Kluwer Health</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160401</creationdate><title>Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases</title><author>Lee, Woo Kyung ; Hwang, Sena ; Kim, Daham ; Lee, Seul Gi ; Jeong, Seonhyang ; Seol, Mi-Youn ; Kim, Hyunji ; Ku, Cheol Ryong ; Shin, Dong Yeop ; Chung, Woong Youn ; Lee, Eun Jig ; Lee, Jandee ; Jo, Young Suk</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4502-2f517defc323ef3d15745768e813df615f213cfe647b2af85c33621ba33eb2a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Critical Illness</topic><topic>Female</topic><topic>Humans</topic><topic>Infections - complications</topic><topic>Inflammation - complications</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observational Study</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Thyroid Gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Woo Kyung</creatorcontrib><creatorcontrib>Hwang, Sena</creatorcontrib><creatorcontrib>Kim, Daham</creatorcontrib><creatorcontrib>Lee, Seul Gi</creatorcontrib><creatorcontrib>Jeong, Seonhyang</creatorcontrib><creatorcontrib>Seol, Mi-Youn</creatorcontrib><creatorcontrib>Kim, Hyunji</creatorcontrib><creatorcontrib>Ku, Cheol Ryong</creatorcontrib><creatorcontrib>Shin, Dong Yeop</creatorcontrib><creatorcontrib>Chung, Woong Youn</creatorcontrib><creatorcontrib>Lee, Eun Jig</creatorcontrib><creatorcontrib>Lee, Jandee</creatorcontrib><creatorcontrib>Jo, Young Suk</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medicine (Baltimore)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Woo Kyung</au><au>Hwang, Sena</au><au>Kim, Daham</au><au>Lee, Seul Gi</au><au>Jeong, Seonhyang</au><au>Seol, Mi-Youn</au><au>Kim, Hyunji</au><au>Ku, Cheol Ryong</au><au>Shin, Dong Yeop</au><au>Chung, Woong Youn</au><au>Lee, Eun Jig</au><au>Lee, Jandee</au><au>Jo, Young Suk</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases</atitle><jtitle>Medicine (Baltimore)</jtitle><addtitle>Medicine (Baltimore)</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>95</volume><issue>14</issue><spage>e3346</spage><epage>e3346</epage><pages>e3346-e3346</pages><issn>0025-7974</issn><eissn>1536-5964</eissn><abstract>Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s).The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes.The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P < 0.0001) and a significant positive association with LOS in the ICU (P = 0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio = 3.101; 95% confidence interval = 1.711-5.618; P < 0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P = 0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P = 0.016).NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27057916</pmid><doi>10.1097/MD.0000000000003346</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Critical Illness Female Humans Infections - complications Inflammation - complications Male Middle Aged Observational Study Retrospective Studies Severity of Illness Index Thyroid Gland |
| title | Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases |
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