Abnormal thyroid and adrenocortical function test results in intensive care patients.
A prospective, cohort study of 75 consecutive patients requiring management in the medical intensive care unit (MICU) of the Singapore General Hospital was carried out over a five-month period to determine thyroid and adrenocortical profiles and evaluate their use in predicting patient outcome. Up to 88% of patients had at least one abnormal thyroid function and 77% had abnormal adrenocortical function test results. There were significantly lower triiodothyronine, thyroxine and free thyroxine, but not thyrotropin levels, and higher cortisol levels in non-survivors compared to survivors (all P < 0.01). Of the endocrine parameters, triiodothyronine and cortisol concentrations were independent predictors of outcome. The overall predictive accuracy of combining these two variables on admission into the MICU was 74%. The APACHE II (acute physiology and chronic health evaluation II) score alone predicted outcome with 71% accuracy, and in combination with triiodothyronine and cortisol levels improved accuracy to 84%. The use of dopamine alone predicted outcome with 74% accuracy, and in combination with triiodothyronine and cortisol levels, improved accuracy to 84%. Measurements of total triiodothyronine and cortisol concentrations on admission to the MICU, and consideration of the use of dopamine improve on the APACHE II score in outcome prediction.
Koh
L K
LK
Department of Endocrinology, Singapore General Hospital, Singapore.
Eng
P H
PH
Lim
S C
SC
Tan
C E
CE
Khoo
D H
DH
Fok
A C
AC
D018806:APACHE; D000293:Adolescent; D000304:Adrenal Cortex Function Tests; D000307:Adrenal Gland Diseases / Q000175:diagnosis*; D000311:Adrenal Glands / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019411:Clinical Laboratory Techniques; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012846:Singapore; D015996:Survival Rate; D013959:Thyroid Diseases / Q000175:diagnosis*; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000473:pathology