Endocrine measurements in survivors and non-survivors from critical illness.
OBJECTIVE
To compare measurements of thyroid and adrenal function between survivors and non-survivors in critical illness.


METHODS
Prospective, observational study at the medical/surgical intensive care unit (ICU) at Royal Infirmary of Edinburgh, Scotland.


METHODS
163 patients admitted to the intensive care unit over a 4-month period.


METHODS
We took blood samples within 1 h of ICU admission, and at 08:00 hours on the subsequent 2 days of ICU admission. We measured serum total (TT(4)) and free (fT(4)) thyroxine, total (TT(3)) and free (fT(3)) tri-iodothyronine, thyrotropin (TSH) and plasma cortisol concentrations.


RESULTS
TT(3) and TT(4) concentrations were significantly less in non-survivors than in survivors on admission and on day 1 but not on day 2. Cortisol concentrations were higher in non-survivors on admission and on day 1 but not on day 2. TSH, fT(3) and fT(4) concentrations did not differ significantly between survivors and non-survivors at any time. Only TT(4) and cortisol were independent predictors of outcome. Prediction of outcome from the admission sample values was not better than using APACHE II scoring.


CONCLUSIONS
Thyroid hormone and cortisol concentrations differ between survivors and non-survivors on admission to intensive care, but the values overlap. These differences do not allow accurate prediction of outcome from critical illness.
Ray
David C
DC
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary, Lauriston Place, Edinburgh, EH3 9YW, UK. david.ray@ed.ac.uk
Macduff
Andrew
A
Drummond
Gordon B
GB
Wilkinson
Ewan
E
Adams
Bill
B
Beckett
Geoff J
GJ
D018806:APACHE; D000311:Adrenal Glands / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D004298:Dopamine / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012606:Scotland; D017741:Survivors; D013961:Thyroid Gland / Q000503:physiopathology*; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood
D005938:Glucocorticoids; D013963:Thyroid Hormones; D013972:Thyrotropin; D004298:Dopamine; D006854:Hydrocortisone