Kovacevic M, Nesek-Adam V, Klokic S, Mujaric E. Low T3 vs low T3T4 euthyroid sick syndrome in septic shock patients: A prospective observational cohort study. World J Crit Care Med 2024; 13(3): 96132 [PMID: 39253312 DOI: 10.5492/wjccm.v13.i3.96132]
Corresponding Author of This Article
Mirza Kovacevic, PhD, Postdoc, Department of Anesthesiology, Resuscitation and Intensive Care, Cantonal Hospital, Crkvice 48e, Zenica 72000, Bosnia and Herzegovina. kovacevic.mirza@hotmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mirza Kovacevic, Department of Anesthesiology, Resuscitation and Intensive Care, Cantonal Hospital, Zenica 72000, Bosnia and Herzegovina
Visnja Nesek-Adam, Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb 10000, Croatia
Semir Klokic, Gruppenpraxis, General Practitioner's Office, Laufen 4242, Switzerland
Ekrema Mujaric, Department of Internal Diseases, Cantonal Hospital, Zenica 72000, Bosnia and Herzegovina
Author contributions: Kovacevic M, Nesek-Adam V contributed to the conception of idea, manuscript draft, revision and critical review; Klokic S and Mujaric E contributed to manuscript revision, figure selection and critical review.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB) of Cantonal Hospital Zenica, and the protocols used in the study were approved by the Ethical Committee of Cantonal Hospital Zenica (00-03-35-38-14/22).
Clinical trial registration statement: This study is registered at ClinTrials.gov. The registration identification number is NCT06242626.
Informed consent statement: All data in the study were used after obtaining informed written consent from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data underlying the results are available as part of the article and no additional source data are required.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mirza Kovacevic, PhD, Postdoc, Department of Anesthesiology, Resuscitation and Intensive Care, Cantonal Hospital, Crkvice 48e, Zenica 72000, Bosnia and Herzegovina. kovacevic.mirza@hotmail.com
Received: April 27, 2024 Revised: June 8, 2024 Accepted: June 24, 2024 Published online: September 9, 2024 Processing time: 124 Days and 13.5 Hours
Abstract
BACKGROUND
Both phases of euthyroid sick syndrome (ESS) are associated with worse prognosis in septic shock patients. Although there are still no indications for supplementation therapy, there is no evidence that both phases (initial and prolonged) are adaptive or that only prolonged is maladaptive and requires supplementation.
AIM
To analyze clinical, hemodynamic and laboratory differences in two groups of septic shock patients with ESS.
METHODS
A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups. The analysis included demographic data, mortality scores, intensive care unit stay, mechanical ventilation length and 28-day survival and laboratory with hemodynamics.
RESULTS
The Simplified Acute Physiology Score II score (P = 0.029), dobutamine (P = 0.003) and epinephrine requirement (P = 0.000) and the incidence of renal failure and multiple organ failure (MOF) (P = 0.000) were significantly higher for the low T3T4. Hypoalbuminemia (P = 0.047), neutrophilia (P = 0.038), lymphopenia (P = 0.013) and lactatemia (P = 0.013) were more pronounced on T2 for the low T3T4 group compared to the low T3 group. Diastolic blood pressure at T0 (P = 0.017) and T1 (P = 0.007), as well as mean arterial pressure at T0 (P = 0.037) and T2 (P = 0.033) was higher for the low T3 group.
CONCLUSION
The low T3T4 population is associated with higher frequency of renal insufficiency and MOF, with worse laboratory and hemodynamic parameters. These findings suggest potentially maladaptive changes in the chronic phase of septic shock.
Core Tip: Euthyroid sick syndrome (ESS) is a significant clinical condition that greatly alters mortality in septic shock patients. Low values of T3 hormone levels have previously been associated with adaptation, while the condition with low T3 and T4 levels are still insufficiently known in terms of the impact on mortality and other pathophysiological mechanisms. This prospective study will give readers knowledge about the two types of ESS, and therefore new insight into hormonal disturbances in septic shock patients with possible thyroid hormone supplementation in the low T3T4 phase.
