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Thyroid function and outcome in children who survived meningococcal septic shock
Marieke den Brinker1, Bertien Dumas, Theo J Visser
1Department of Pediatrics, Division of Pediatric Intensive Care, Erasmus Medical Center - Sophia Children's Hospital, 3000 CB, Rotterdam, The Netherlands.
Intensive Care Medicine
|June 21, 2005
Summary
Thyroid function changes in children with meningococcal septic shock predict intensive care unit stay duration. Early thyroid hormone alterations indicate prognosis in pediatric septic shock survivors.
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Infectious diseases
Background:
- Meningococcal septic shock is a severe condition requiring intensive care.
- Thyroid dysfunction is common in critically ill patients, but its course in pediatric septic shock is not well understood.
Purpose of the Study:
- To examine thyroid function dynamics in children surviving meningococcal septic shock.
- To identify factors influencing thyroid function and its correlation with patient outcomes, specifically length of pediatric intensive care unit (PICU) stay.
Main Methods:
- Observational cohort study involving 44 children who survived meningococcal septic shock in a pediatric intensive care unit.
- Serum thyroid hormone levels (total triiodothyronine, reverse triiodothyronine, total thyroxine, free thyroxine, thyrotropin) were measured at admission, 24 hours, and 48 hours.
- Disease severity was assessed using the Pediatric Risk of Mortality score and laboratory markers; patients were categorized into short-stay (<7 days) and long-stay (≥7 days) groups.
Main Results:
- All children exhibited euthyroid sick syndrome on admission, characterized by low total triiodothyronine and high reverse triiodothyronine.
- Admission reverse triiodothyronine levels and the total triiodothyronine/reverse triiodothyronine ratio correlated with C-reactive protein and time to admission.
- Short-stay patients had higher admission total triiodothyronine and lower interleukin-6 levels compared to long-stay patients. At 48 hours, short-stay patients showed improved thyroid hormone profiles and higher thyrotropin levels.
- Changes in thyroid parameters within 24 hours of admission were associated with the length of PICU stay.
- Dopamine administration affected thyrotropin levels and the total triiodothyronine/reverse triiodothyronine ratio.
Conclusions:
- Children surviving meningococcal septic shock consistently present with euthyroid sick syndrome.
- The trajectory of thyroid hormone levels within the initial 24 hours post-admission is a significant predictor of PICU length of stay in this population.