ESPE2022 Poster Category 1 Thyroid (44 abstracts)
Biochemical Indicators of Euthyroid Sick Syndrome in Critically Ill Children
Tolga Besci 1 , Özge Besci 2 , Gazi Arslan 1 , Hande Ilgaz 3 , Pınar Prencuva 3 , Göktuğ Özdemir 1 , Ayhan Abacı 2 & Korcan Demir 2
1Division of Pediatric Critical Care, Dokuz Eylül University, İzmir, Turkey; 2Division of Pediatric Endocrinology, Dokuz Eylul University, İzmir, Turkey; 3Department of Pediatrics, Dokuz Eylul University, İzmir, Turkey
Purpose: This study aimed to determine the prevalence and predictors of Euthyroid Sick syndrome (ESS) in pediatric intensive care, and to establish a link between thyroid function tests and mortality.
Methods: Between January 2015 and March 2020, children admitted to our pediatric intensive care unit (PICU) and tested for free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) levels were included. Patients with decreased fT3, normal or decreased fT4, and normal or decreased TSH levels were assigned to the ESS group. The association between biochemical indicators and ESS, as well as the relationship between fT3 and mortality, were examined.
Results: 141 (36%) of children were classified in the ESS group. The ESS group had a higher rate of 28-day mortality (12 [8.5%] vs 9 [3.7%]). Blood urea nitrogen (BUN), albumin, platelet, lactate, and pediatric index of mortality 3 [PIM3 (%)] were significantly associated with ESS (odds ratios in order: 1.024, 0.422, 0.729, 1.208, 1.013). Multivariate regression analysis showed that BUN, albumin, platelet, and lactate were independently associated with ESS progression. The area under curve (AUC [95%CI]) for fT3 was 0.644 (0.555–0.789) to detect mortality. Children with a fT3 level lower than 2.31 pg/ml had significantly higher 28-day mortality (log-rank test, P=0.001).
Conclusion: Our study identified BUN, albumin, lactate, and platelet count as independent risk factors for ESS progression in children. Furthermore, our findings indicated a correlation between fT3 and mortality, which makes fT3 an ideal candidate to be included in mortality indices.
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