Abnormal thyroid and adrenocortical function test results in intensive care patients

Area of Science:

• Endocrinology
• Critical Care Medicine

Background:

• Critically ill patients often exhibit endocrine dysfunction.
• Thyroid and adrenocortical function abnormalities are common in the medical intensive care unit (MICU).

Purpose of the Study:

• To determine thyroid and adrenocortical profiles in MICU patients.
• To evaluate the utility of these profiles in predicting patient outcomes.
• To assess if endocrine markers improve existing outcome prediction scores.

Main Methods:

• Prospective cohort study of 75 consecutive MICU patients.
• Measurement of thyroid function tests (triiodothyronine, thyroxine, free thyroxine, thyrotropin) and cortisol levels.
• Comparison of endocrine profiles between survivors and non-survivors.
• Evaluation of predictive accuracy using APACHE II score and dopamine use.

Main Results:

• High prevalence of abnormal thyroid (88%) and adrenocortical (77%) function.
• Non-survivors showed lower triiodothyronine and higher cortisol levels compared to survivors (P < 0.01).
• Triiodothyronine and cortisol were independent predictors of outcome.
• Combining triiodothyronine and cortisol with APACHE II or dopamine improved predictive accuracy to 84%.

Conclusions:

• Thyroid and adrenocortical dysfunction are prevalent in MICU patients.
• Triiodothyronine and cortisol levels are significant predictors of outcome.
• Integrating endocrine markers with clinical scores enhances patient outcome prediction in the MICU.