Abstract
Introduction: Critical illness and sepsis are difficult to treat with increasing age because of the poor adaptive physiological system as age progresses. The study tries to identify prognostic markers among thyroid hormones for post-surgical critically ill subjects, who have sepsis, to improve the outcome of patients with increasing age.
 Methods: Free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were estimated by ARCHITECT immunoassay kits in 127 post-surgical critically ill patients with sepsis. Sequential Organ Failure Assessment (SOFA) score was recorded for each patient.
 Results: The FT3, FT4 and TSH levels decreased and SOFA score increased with increasing age. Thyroid markers were significantly inversely correlated with age (for FT4 r= -0.616, p<0.0001 and for TSH r= -0.453, p<0.0001), with the strongest correlation between FT3 and age (r=0.674, p<0.0001). A positive correlation was observed between SOFA score and age (r=0.577, p<0.0001). FT3 decreases, SOFA and age increase from improved prognosis to worst prognosis (p<0.0001).
 Conclusions: FT3 surfaced as a prominent prognostic marker that may be used in predicting the prognosis of post-surgical critically ill geriatric patients with sepsis.
Highlights
Critical illness and sepsis are difficult to treat with increasing age because of the poor adaptive physiological system as age progresses
Sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection with known or suspected infection with a change in Sequential Organ Failure Assessment (SOFA) score ≥ 2, or a modified “quick SOFA” for simpler use
Clinical features are selected for systemic inflammatory response (SIRS) as markers, which are; temperature > 38 °C or 36 °C, heart rate > 90 beats/min, respiratory rate > 20 breaths/min or paCO2 < 32 torrs (4.3 kPa), WBC > 12000 cells/mm3, while in case of sepsis these responses are for infection and generally two or more SIRS criteria are related to sepsis
Summary
Critical illness and sepsis are difficult to treat with increasing age because of the poor adaptive physiological system as age progresses. The study tries to identify prognostic markers among thyroid hormones for post-surgical critically ill subjects, who have sepsis, to improve the outcome of patients with increasing age. Methods: Free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) were estimated by ARCHITECT immunoassay kits in 127 post-surgical critically ill patients with sepsis. Sequential Organ Failure Assessment (SOFA) score was recorded for each patient. Conclusions: FT3 surfaced as a prominent prognostic marker that may be used in predicting the prognosis of post-surgical critically ill geriatric patients with sepsis. Sepsis is defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection with known or suspected infection with a change in Sequential Organ Failure Assessment (SOFA) score ≥ 2, or a modified “quick SOFA” for simpler use.
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