title: Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases.
abstract: Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s).The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes.The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P < 0.0001) and a significant positive association with LOS in the ICU (P = 0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio = 3.101; 95% confidence interval = 1.711-5.618; P < 0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P = 0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P = 0.016).NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.
authors.affiliation: From the Department of Internal Medicine (WKL, SH, DK, SJ, CRK, DYS, EJL, YSJ); Department of Surgery (SGL, M-YS, HK, WYC, JL); Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine; and Brain Korea 21 PLUS Project for Medical Science (WKL, EJL), Yonsei University, Seoul, Korea.
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Lee
authors.forename: Sena
authors.initials: S
authors.lastname: Hwang
authors.forename: Daham
authors.initials: D
authors.lastname: Kim
authors.forename: Seul Gi
authors.initials: SG
authors.lastname: Lee
authors.forename: Seonhyang
authors.initials: S
authors.lastname: Jeong
authors.forename: Mi-Youn
authors.initials: MY
authors.lastname: Seol
authors.forename: Hyunji
authors.initials: H
authors.lastname: Kim
authors.forename: Cheol Ryong
authors.initials: CR
authors.lastname: Ku
authors.forename: Dong Yeop
authors.initials: DY
authors.lastname: Shin
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Eun Jig
authors.initials: EJ
authors.lastname: Lee
authors.forename: Jandee
authors.initials: J
authors.lastname: Lee
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Jo
mesh_terms: D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications*; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013961:Thyroid Gland