Thyroid hormone levels and their relationship to survival in children with bacterial sepsis and septic shock.
OBJECTIVE
Reported studies have showed alternations of thyroid hormones in critical illness mostly in adults and some in children. In this study, we aimed to measure thyroid hormone levels in children with sepsis and septic shock and investigate the relationship of these hormones with clinical state and survival.


METHODS
Thyroid hormone levels of children with sepsis and septic shock, and age- and sex-matched controls were measured.


RESULTS
There were 51 children in sepsis (group S), 21 children in septic shock (group SS) and 30 in the control (group C) group. Total triiodothyronine (TT3) levels were (nmol/l): 0.91 +/- 0.22, 0.64 +/- 0.23, 2.11 +/- 0.59; free triiodothyronine (FT3) (pmol/l): 0.027 +/- 0.006, 0.018 +/- 0.007, 0.049 +/- 0.010; total thyroxine (TT4) (nmol/l): 100.62 +/- 21.93, 65.79 +/- 19.35, 109.65 +/- 19.35; free thyroxine (FT4) (pmol/l): 18.06 +/- 3.87, 10.32 +/- 1.29, 19.35 +/- 3.87; and thyroid stimulating hormone (TSH) (mIU/ml): 5.0 +/- 2.0, 4.8 +/- 2.4, 5.2 +/- 3.0, in children with sepsis, septic shock, and controls, respectively. The TT3, FT3, TT4, and FT4 levels of group SS were significantly lower than those of groups S and C. The TT3 and FT3 levels of group S were lower than in group C, but there was no significant difference between TT4, and FT4 levels of groups S and C. TSH levels were slightly decreased in both sepsis and septic shock, but the difference was not significant. Eleven (21.6%) children with sepsis and 15 (71.4%) children with septic shock died (p < 0.001). The levels of TT3, FT3, TT4 and FT4 were markedly lower in non-survivors of groups S and SS compared to survivors (p < 0.001).


CONCLUSIONS
These changes in the hypothalamo-pituitary-thyroidal axis may suggest a possible prognostic value of thyroid hormone levels in children with sepsis and septic shock. To the best of our knowledge, this report is the first study to compare thyroid hormone levels in a large number of patients with sepsis and septic shock with those in healthy controls in childhood.
Yildizdaş
Dincer
D
Pediatric Intensive Care Unit, Cukurova University, Adana, Turkey. rdy90@hotmail.com
Onenli-Mungan
Neslihan
N
Yapicioğlu
Hacer
H
Topaloğlu
Ali Kemal
AK
Sertdemir
Yaşar
Y
Yüksel
Bilgin
B
D016470:Bacteremia / Q000097:blood* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D011237:Predictive Value of Tests; D012016:Reference Values; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality; D016019:Survival Analysis; D013972:Thyrotropin / Q000097:blood*; D013974:Thyroxine / Q000097:blood*; D014284:Triiodothyronine / Q000097:blood*
D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine