Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation.
BACKGROUND
Emergency operation in the elderly carries a high risk of death. We investigated the incidence of euthyroid sick syndrome (ESS) and associated nutritional and endocrine abnormalities and their relationship to postoperative outcome in this population.


METHODS
Sixty-six patients older than 70 years of age requiring emergency operations were assessed before any therapeutic intervention. Values for thyroid hormones, catecholamines, cortisol, interleukin-6, interleukin-1, C-reactive protein, and the Acute Physiology and Chronic Health Evaluation II score were determined. Nutritional assessment was carried out. Mortality rates and duration of hospital stay were related to ESS and albumin concentrations.


RESULTS
ESS was diagnosed in 34 patients (51.50%) and was associated with worse Acute Physiology and Chronic Health Evaluation II scores (10.9 vs 8.6; p = 0.004), hypoalbuminemia (34.7 vs 40.8 gm/L; p = 0.0001), lower triceps skinfold (11.8 vs 14.6 mm; p = 0.03), and higher cortisol and norepinephrine levels (937 vs 741 nmol/L [p = 0.04] and 358 vs 250 pg/ml [p = 0.02], respectively), interleukin-6 plasma concentrations (347 vs 113 pg/ml; p = 0.01), death rate (20% vs 0%; p = 0.02), and length of hospital stay (17.2 vs 11.8 days; p = 0.03). A serum albumin level less than 35 gm/L was virtually always associated with ESS.


CONCLUSIONS
ESS is highly prevalent in the elderly with acute surgical problems and is associated with poor nutrition, higher sympathetic response, and worse postoperative outcome. The serum albumin level at admission is a specific marker of ESS.
Girvent
M
M
Department of Surgery, Hospital Universitari del Mar, Barcelona, Spain.
Maestro
S
S
Hernández
R
R
Carajol
I
I
Monné
J
J
Sancho
J J
JJ
Gubern
J M
JM
Sitges-Serra
A
A
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D003141:Communicable Diseases / Q000601:surgery; D004630:Emergencies; D005067:Euthyroid Sick Syndromes / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D050723:Fractures, Bone / Q000601:surgery*; D018737:Hand Strength; D006728:Hormones / Q000097:blood*; D006801:Humans; D015994:Incidence; D007238:Infarction / Q000601:surgery; D007415:Intestinal Obstruction / Q000601:surgery*; D007422:Intestines / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D009638:Norepinephrine / Q000097:blood; D015596:Nutrition Assessment; D010538:Peritonitis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012885:Skinfold Thickness; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000097:blood; D014285:Triiodothyronine, Reverse / Q000097:blood
D006728:Hormones; D012709:Serum Albumin; D014284:Triiodothyronine; D014285:Triiodothyronine, Reverse; D002097:C-Reactive Protein; D009638:Norepinephrine