title: Dynamic neuroendocrine changes in critically ill patients with polytrauma.
abstract: OBJECTIVE
  Acute multiple-trauma induces activation of neuroendocrine system. Nonthyroidal illness syndrome (NTIS) is considered to be associated with adverse outcome in intensive care unit (ICU) patients. This study was aimed to assess dynamic changes of neuroendocrine hormones in patients with polytrauma and their association with the polytrauma score (PTS).
  
  
  METHODS
  Blood samples from 24 critically ill patients with polytrauma were obtained on 1st, 2nd, 3rd and 7th day after admission to ICU for analysis of thyroid-stimulating hormone (TSH), total triiodothyronine (T3); free triiodothyronine (fT3), total thyroxine (T4), free thyroxine (fT4), growth hormone (GH), prolactin (PRL) and procalcitonin levels.
  
  
  RESULTS
  Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16±5 points on average at the admission to ICU. All patients had normal baseline TSH, T4, fT4, but low T3, and fT3 levels were found in 20% and 33% ICU patients, respectively. On the 7th day after admission to ICU TSH had tendency to increase (p=0.07) and fT4 significantly decreased (p=0.03). The PRL level significantly increased on the 3rd day after admission as compared to 1st day (p=0.04). PTS positively correlated with fT3 (r=0.582, p=0.004) and negatively with fT4 (r=-0.422, p=0.04) at the 1st day in ICU.
  
  
  CONCLUSIONS
  Critical illness in patients with polytrauma leaded to trauma severity-dependent alterations of the thyroid axis response early after injury. Our findings suggest that detection of dynamic hormonal response is more appropriate than single measurement. However supplemental therapy for NTIS should be used after more detailed studies are completed.
authors.affiliation: Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Galusova
authors.affiliation: Department Anesthesiology and Intensive Medicine, Derer's Hospital, Bratislava University Hospital, Bratislava, Slovakia.
authors.forename: Matus
authors.initials: M
authors.lastname: Pauliny
authors.affiliation: Department Anesthesiology and Intensive Medicine, Derer's Hospital, Bratislava University Hospital, Bratislava, Slovakia.
authors.forename: Milan
authors.initials: M
authors.lastname: Majek
authors.affiliation: Department Anesthesiology and Intensive Medicine, Derer's Hospital, Bratislava University Hospital, Bratislava, Slovakia.
authors.forename: Jaroslava
authors.initials: J
authors.lastname: Mackova
authors.affiliation: Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
authors.forename: Milada
authors.initials: M
authors.lastname: Meskova
authors.affiliation: Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Vlcek
authors.affiliation: Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
authors.forename: Richard
authors.initials: R
authors.lastname: Imrich
authors.affiliation: Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia.
authors.forename: Adela
authors.initials: A
authors.lastname: Penesova
mesh_terms: D018806:APACHE; D000328:Adult; D002116:Calcitonin / Q000378:metabolism*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D016638:Critical Illness; D005067:Euthyroid Sick Syndromes / Q000209:etiology / Q000378:metabolism*; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000378:metabolism*; D011388:Prolactin / Q000378:metabolism*; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism*; D013972:Thyrotropin / Q000378:metabolism*; D013974:Thyroxine / Q000378:metabolism*; D014284:Triiodothyronine / Q000378:metabolism*
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D014284:Triiodothyronine; D019382:Human Growth Hormone; D011388:Prolactin; D013972:Thyrotropin; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide; D013974:Thyroxine