Abstract
BackgroundNonthyroidal illness syndrome (NTIS) is common in critical illness and is associated with poor prognosis. The aim of this study was to find the prevalence, charateristics, and prognosis of NTIS and its correlation with outcomes in AP patients.MethodsA retrospective review of AP patients with a diagnosis of NTIS from Jan 2012 to September 2020 was performed. The serum thyroidal hormone (TH) disturbances, as well as the demographic characteristics and clinical outcomes of the study patients, were collected and analyzed.ResultsOver the eight years, 183 included AP patients were diagnosed as NTIS, constituting an incidence of 64.7%. Patients with NTIS were admitted with worse condition based on the higher APACHE II score, SOFA score, Balthazar's CT score, CRP and lower albumin than euthyroid patients. Also, these patients had a longer ICU duration (3, 2–10 vs 2, 0–3, days, P = 0.039) and tended to be more likely to develop infected pancreatic necrosis (IPN) (15.3% vs 6.3%, P = 0.087) and gastrointestinal fistula (6% vs 0%, P = 0.082) than euthyroid patients. Free triiodothyronine (FT3) was found the best performance in predicting death compared by other well-recognized biomarkers.ConclusionNTIS is common in AP patients within 7 days after the onset of the disease. NTIS is associated with the worse characteristics at admission and poor outcome during the course. FT3 should be investigate as a potential biomarker in the prediction of death in AP patients.
Highlights
Nonthyroidal illness syndrome (NTIS) is common in critical illness and is associated with poor prognosis
Previous studies reported that moderately severe Acute pancreatitis (AP) (MSAP) and severe AP (SAP) patients were tested with low Free triiodothyronine (FT3) levels than moderately AP (MAP) patients and monitoring free triiodothyronine (FT3) levels in the early stage of AP is helpful to evaluate disease severity [13, 14]
Patients in the NTIS group were admitted with higher APACHE II score (6.9 ± 5.0 vs 4.1 ± 3.5, P < 0.001), sequential organ failure assessment (SOFA) score (2.5 ± 3.0 vs 1.2 ± 1.9, P < 0.001), CTSI score (6.3 ± 2.0 vs 4.9 ± 1.7, P < 0.001), C-reactive protein (CRP) (154.1 ± 79.9 vs 127.0 ± 81.3, mg/L, P = 0.039) and lower albumin (30.9 ± 4.3 vs 33.0 ± 5.8, g/L, P = 0.004) with a significant difference
Summary
Nonthyroidal illness syndrome (NTIS) is common in critical illness and is associated with poor prognosis. Nonthyroidal illness syndrome (NTIS), known as the low T3 syndrome or euthyroid sick syndrome, is characterized by low serum levels of free and total triiodothyronine (T3) with normal or low thyroid-stimulating hormone (TSH) [1, 2]. Such typical changes of the serum thyroidal hormone (TH) differ from those in primary or secondary thyroid disorders and refer to distortions in. The present study was performed to evaluate the thyroid function and the prevalence, underlying mechanisms, and its correlation with clinical variables and prognosis of NTIS in adult patients with AP
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