title: Predictive value of thyroid hormones on the first day in adult respiratory distress syndrome patients admitted to ICU: comparison with SOFA and APACHE II scores.
abstract: BACKGROUND
  Thyroid hormone dysfunction could affect outcome and increase mortality in critical illness. Therefore, in a prospective, observational study we analyzed and compared the prognostic accuracy of free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), along with the APACHE II and SOFA scoring systems in predicting intensive care unit (ICU) mortality in critically ill patients.
  
  
  METHODS
  Physiology scores were calculated for the first 24 hours after ICU admission in 206 patients with acute respiratory distress syndrome. APACHE II and SOFA scores were employed to determine the initial severity of illness. Thyroid hormones were measured within the first 24 hours. Logistic regression models were created for APACHE II scores, SOFA scores, and thyroid hormone levels. The models predicted high- and low-risk subgroups. Models that showed a good fit were stratified by Kaplan-Meier survival curves.
  
  
  RESULTS
  There were 98 (47.6%) survivors and 108 (52.4%) non-survivors. The survivors had a lower APACHE II score (11.50 vs 15.82, P < 0.0005), a lower SOFA score (6.06 vs 9.42, P < 0.0005), a younger age (57 vs 70 years, P = 0.008), a shorter ICU stay (13 vs 16 days, P = 0.012), and a higher fT3 level (2.18 vs 1.72 pg/mL, P = 0.002) than non-survivors. ICU survival was most closely predicted by a model that included age and fT3 and a model that included APACHE II and APACHE II*sex.
  
  
  CONCLUSIONS
  In critically ill patients, serum fT3 concentrations markedly decreased after ICU admission among non-survivors. According to our findings, fT3 levels might have additive discriminatory power to age, SOFA and APACHE II scores in predicting short-term mortality in ARDS patients admitted to ICU.
authors.affiliation: Trakya University Medical Faculty, Department of Biostatistics, Edirne, Turkey. ture@trakya.edu.tr
authors.forename: Mevlü
authors.initials: M
authors.lastname: Türe
authors.forename: Dilek
authors.initials: D
authors.lastname: Memiş
authors.forename: Imran
authors.initials: I
authors.lastname: Kurt
authors.forename: Zafer
authors.initials: Z
authors.lastname: Pamukçu
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000401:mortality*; D012720:Severity of Illness Index; D013963:Thyroid Hormones / Q000097:blood*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D013963:Thyroid Hormones; D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine