Relationship between thyroid function and ICU mortality: a prospective observation study
Feilong Wang, Wenzhi Pan, Hairong Wang, Shuyun Wang, Shuming Pan and Junbo Ge
Critical Care 2012, 16:R11
Introduction
Although the nonthyroidal illness syndrome (NTIS) is considered to be associated with adverse outcome in ICU patients, the performance of thyroid hormones to predict clinical outcome in ICU patients is unimpressive. The study was conducted to assess the prognostic value of the complete thyroid indicators (FT3, TT3, FT4, TT4, TSH and rT3) in unselected ICU patients.
Methods. 480 consecutive patients without known thyroid diseases were screened for eligibility and followed up during the ICU stay. We collected each patient's baseline characteristics including the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, thyroid hormones levels, N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP). The primary outcome was ICU mortality. Potential predictors were analyzed for possible association with outcomes. We also evaluated the ability of thyroid hormones additive to APACHE-II score to predict ICU mortality by calculation of net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. Results. Among the thyroid hormonal indicators, FT3 had the greatest power for predicting ICU mortality, as suggested by the largest area under the curve (AUC) of 0.762+/-0.028. The AUC for FT3 was less than that for APACHE-II score (0.829 +/-0.022), but greater than that for NT-proBNP (0.724+/-0.030) or CRP (0.689+/-0.030). Multiple regression revealed that FT3 (standardized beta=-0.600, P=0.001), APACHE- score (standardized beta = 0.912, P<0.001), NT-proBNP (standardized beta=0.459, P=0.017) or CRP (standardized beta = 0.367, P=0.030) could independently predict primary outcome. Addition of FT3 to APACHE- score gave an NRI of 54.29% (P<0.001) and IDI of 36.54% (P<0.001). The level of FT3 was significantly correlated with. NT-proBNP (r=-0.344, P<0.001) or CRP (r=-0.408, P<0.001) levels. Conclusion. In unselected ICU patients, FT3 was the most powerful and only independent predictor of ICU mortality among the complete indicators. Addition of FT3 to the APACHE- score could significantly improve the ability to predict ICU mortality
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