EUTHYROID SICK SYNDROME: PREVALENCE AND PROGNOSIS IN ELDERLY PATIENTS WITH SEPSIS

Abstract

Objective: Euthyroid sick syndrome (ESS) manifests by the decreased level of serum free thyroid hormones and with the normal or decreased secretion of thyroid-stimulating hormone. The study aims to identify the prevalence of ESS in elderly patients with sepsis and evaluate its possible effect on prognosis and mortality. Material and Methods: Two hundred and three patients diagnosed with sepsis were prospectively evaluated. They were divided into two groups, a geriatric group (≥65 years), and a control group (<65 years). Patients with low free T3 (fT3) and/or free T4 (fT4) were considered to have euthyroid-sick syndrome. The demographic characteristics, comorbidities, laboratory results, hospitalization data, intensive care unit (ICU) duration, treatment outcomes, and mortality rates of the patients were recorded and compared. Results: The incidence of ESS was significantly higher in the geriatric group (88.5% vs. 77.8%) (p=0.04). There was no difference between the groups in regard to mortality rate and ICU stay. However, 91.3% of deceased patients in the entire group and all deceased patients in the geriatric group were ESS (+) patients. The mean fT3 was significantly decreased in the deceased patients, and ICU patients (p=0.017). Additionally, the decreased levels of fT4 in both the entire group and the geriatric group were significantly associated with mortality and ICU stay (p-value: 0.020 and 0.019, respectively). Conclusions: The higher prevalence of ESS (88.5%) in elderly patients with sepsis was clearly demonstrated. Additionally, approximately two-fold higher mortality and ICU stay risk was documented in the ESS (+) group. Thus, simply screening of ESS in septic elderly patients will certainly contribute to treatment decisions and early prediction of complicated clinical course and poor prognosis.