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
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World J Crit Care Med. Sep 9, 2024; 13(3): 96132 Published online Sep 9, 2024. doi: 10.5492/wjccm.v13.i3.96132
Table 1 Demographic parameters, mortality scores, mechanical ventilation and outcome
Parameters
Group
P value
Low T3
Low T3T4
Age in years
64.8 ± 9.7
62.1 ± 15.9
0.483
Sex
Male
12 (50)
10 (43.5)
0.765
Female
12 (50)
13 (56.5)
BMI
25.8 ± 5.4
26.6 ± 5.4
0.712
APACHE II
18.8 ± 6.9
20.8 ± 7.7
0.398
SAPS II
52.5 ± 13.1
59.0 ± 15.5
0.046
SOFA
10.6 ± 2.8
10.6 ± 4.6
0.857
Outcome
Discharge
16 (66.6)
11 (47.8)
0.125
Death
8 (33.3)
12 (52.1)
ICU stay in days
13.6 ± 25.0
22.0 ± 21.0
0.837
MV in days
9.5 ± 3.1
15.4 ± 19.3
0.906
Table 2 Vasopressor requirement and complications according to the groups
Parameters
Group
P value
Low T3
Low T3T4
Vasopressors, No/Yes (%)
Norepinephrine
0/24 (0.0/100.0)
0/23 (0.0/100.0)
Constant
Vasopressin
9/15 (37.2/62.5)
12/11 (54.2/45.8)
0.311
Dobutamine
14/10 (58.3/41.7)
4/19 (17.4/82.6)
0.003
Epinephrine
18/6 (75.0/25.0)
4/19 (17.4/82.6)
0.000
Complications, No/Yes (%)
Pneumonia
19/5 (79.2/20.8)
16/7 (69.6/30.4)
0.450
ARDS
16/8 (66.7/33.3)
15/8 (65.2/34.8)
0.916
Renal failure
20/4 (83.3/16.7)
7/16 (30.4/69.6)
0.000
Liver failure
18/6 (75.0/25.0)
20/3 (87.0/13.0)
0.297
MOF
19/5 (79.2/20.8)
6/17 (26.1/73.9)
0.000
Table 3 Blood count, thyroid hormones and albumin values according to the groups
Parameter
Time
Group
P value
Low T3
Low T3T4
95%CI
Leukocytes as × 109/L, median
T0
15.66
11.21
0.15 to 0.16
0.200
T1
10.51
13.34
0.81 to 0.83
0.220
T2
10.15
13.54
0.61 to 0.63
0.082
Erythrocytes as × 109/L, median
T0
4.21
4.01
0.46 to 0.48
0.231
T1
3.96
3.81
0.61 to 0.63
0.216
T2
3.78
2.85
0.53 to 0.51
0.335
Platelets as × 109/L, median
T0
227.00
147.00
0.08 to 0.10
0.206
T1
209.00
142.00
0.24 to 0.26
0.180
T2
180.00
180.50
0.36 to 0.38
0.160
TSH in mIU/L, median
T0
1.30
0.88
0.24 to 0.25
0.246
T1
1.01
0.78
0.73 to 0.75
0.755
T2
1.18
1.00
0.40 to 0.42
0.417
FT3 in pmol/L, median
T0
3.99
3.52
0.20 to 0.22
0.206
T1
4.64
4.72
0.92 to 0.93
0.929
T2
6.35
4.75
0.34 to 0.36
0.354
FT4 in pmol/L), median
T0
17.30
9.20
0.00 to 0.00
0.000
T1
17.35
10.70
0.02 to 0.03
0.035
T2
15.15
11.40
0.05 to 0.06
0.064
Albumin in g/L, mean ± SD
T0
27.29 ± 4.57
27.74 ± 4.64
-4.17 to 1.58
0.372
T1
28.46 ± 3.29
27.39 ± 3.88
-4.40 to 0.15
0.131
T2
29.75 ± 2.91
28.17 ± 6.41
-3.89 to -0.23
0.047
Table 4 Inflammatory parameters and blood gas analyzes
Parameter
Time
Group
P value
Low T3
Low T3T4
95%CI
Median
Neutrophils 1
T
0.88
0.86
0.29-0.31
0.300
T1
0.88
0.85
0.19-0.21
0.391
T2
0.86
0.82
0.03-0.04
0.038
Lymphocytes 1
T0
0.05
0.05
0.45-0.47
0.464
T1
0.06
0.07
0.17-0.19
0.182
T2
0.01
0.09
0.01-0.02
0.013
CRP in mg/dL
T0
89.00
106.00
0.92-0.93
0.923
T1
145.50
153.00
0.54-0.56
0.559
T2
119.00
77.60
0.08-0.09
0.436
PCT in ng/mL
T0
3.85
5.88
0.44-0.46
0.452
T1
7.55
4.27
0.29-0.31
0.310
T2
2.47
5.50
0.50-0.52
0.492
pH
T0
7.35
7.33
0.44-0.46
0.459
T1
7.31
7.39
0.28-0.29
0.287
T2
7.35
7.46
0.14-0.15
0.149
pCO2 in kPa
T0
5.52
5.06
0.18-0.19
0.198
T1
5.19
5.59
0.30-0.32
0.318
T2
5.82
5.10
0.85-0.86
0.864
pO2 in kPa
T0
11.73
12.10
0.44-0.46
0.448
T1
10.39
13.59
0.82-0.84
0.829
T2
9.59
12.10
0.92-0.93
0.929
HCO3 in mmol/L
T0
21.45
21.00
0.43-0.45
0.439
T1
20.70
23.25
0.65-0.67
0.663
T2
22.70
23.70
0.41-0.43
0.413
Lactate in mmol/L
T0
3.70
2.50
0.40-0.41
0.409
T1
2.50
1.85
0.14-0.16
0.146
T2
2.00
2.55
0.01-0.02
0.013
Table 5 Vasoactive drug-dependent index, shock index and inflammatory prognostic scores
Parameter
Time
Group
P value
Low T3
Low T3T4
95%CI
VDI
T0
0.11
0.13
0.65-0.67
0.655
T1
0.03
0.06
0.41-0.43
0.419
T2
0.00
0.00
0.93-0.94
0.934
SI
T0
1.21
0.00
0.31-0.33
0.322
T1
0.75
0.86
9.14-0.15
0.148
T2
0.70
0.79
0.32-0.34
0.329
NLR
T0
15.00
12.00
0.29-0.31
0.298
T1
15.00
13.00
0.21-0.23
0.218
T2
12.00
7.00
0.03-0.04
0.037
PLR
T0
30.55
21.09
0.26-0.28
0.550
T1
30.26
20.20
0.17-0.18
0.483
T2
23.40
20.00
0.50-0.52
0.496
PI
T0
42.52
60.78
0.20-0.22
0.206
T1
69.14
55.71
0.21-0.23
0.225
T2
82.10
29.98
0.05-0.06
0.129
Citation: 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