Non-thyroid disease syndrome: a strong prognostic predictor of death in patients with pneumonia
1Department of Emergency Medicine, Izmir Atatürk Training and Research Hospital, 35150 Izmir, Turkey
2Department of Emergency Medicine, Republic of Turkey Ministry of Health Basaksehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
DOI: 10.22514/sv.2021.069 Vol.17,Issue 5,September 2021 pp.137-141
Submitted: 19 February 2021 Accepted: 17 March 2021
Published: 08 September 2021
Introduction: Non-thyroid disease syndrome (NTDS) is a common syndrome in critical diseases and is characterized by below-normal levels of free T3 (fT3) and free T4 (fT4) in the absence of primary thyroid gland pathology. Pneumonias are a group of respiratory system infections that are associated with a high incidence of mortality. Rapid biomarkers are needed to determine the diagnosis and prognosis in patients with pneumonia to optimize treatment potential. This study investigated the effect of changes in thyroid hormone and procalcitonin (PCT) levels on prognosis and mortality in patients with pneumonia.
Method: This study was conducted as a retrospective observational study in a tertiary hospital. Between 2019 and 2020, 1118 patients with pneumonia were included in the study. For all participants, PSI scores were calculated and disease severity was determined according to these scores. Patient demographic and disease data were recorded.
Discussion and Conclusion: Low fT3 hormone levels in patients diagnosed with pneumonia upon arrival at the emergency department had an important effect on prognosis. Our results indicated that fT3 levels had a reliable predictive effect on prognosis, disease severity, and mortality. In addition, we found that fT3 was superior to PCT in predicting mortality.
Emergency Service; Pneumonia; Euthyroid Sick Syndromes; Diagnosis
Ejder Saylav Bora,Adem Çakır,Serkan Hacar,Cüneyt Arıkan,Güner Yurtsever,Hüseyin Acar. Non-thyroid disease syndrome: a strong prognostic predictor of death in patients with pneumonia. Signa Vitae. 2021. 17(5);137-141.
 Meyer S, Schuetz P, Wieland M, Nusbaumer C, Mueller B, Christ-Crain M. Low triiodothyronine syndrome: a prognostic marker for outcome in sepsis? Endocrine. 2011; 39: 167–174.
 Akcay I, Okoh AK, Yalav O, Eray IC, Rencuzogullari A, Dalci K, et al. The prognostic value of pro-calcitonin, CRP and thyroid hormones in secondary peritonitis: a single-center prospective study. Turkish Journal of Trauma & Emergency Surgery. 2016; 20: 343–352.
 Duława A, Bułdak Ł, Krysiak R, Okopień B. Hormonal supplementation in endocrine dysfunction in critically ill patients. Pharmacological Reports. 2007; 59: 139–149.
 Fliers E, Bianco AC, Langouche L, Boelen A. Thyroid function in critically ill patients. The Lancet Diabetes & Endocrinology. 2015; 3: 816–825.
 Sahana PK, Ghosh A, Mukhopadhyay P, Pandit K, Chowdhury BR, Chowdhury S. A study on endocrine changes in patients in intensive care unit. Journal of the Indian Medical Association. 2008; 106: 362–364.
 Warner MH, Beckett GJ. Mechanisms behind the non-thyroidal illness syndrome: an update. The Journal of Endocrinology. 2010; 205: 1–13.
 Nobre V, Borges I. Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections. Revista Brasileira de Terapia Intensiva. 2017; 28: 179–189.
 Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Leven M, et al. Guidelines for the management of adult lower respiratory tract infections. The European Respiratory Journal. 2005; 26: 1138–1180.
 Rothwell PM, Lawler PG. Prediction of outcome in intensive care patients using endocrine parameters. Critical Care Medicine. 1995; 23: 78–83.
 Plikat K, Langgartner J, Buettner R, Bollheimer LC, Woenckhaus U, Schölmerich J, et al. Frequency and outcome of patients with nonthy-roidal illness syndrome in a medical intensive care unit. Metabolism: Clinical and Experimental. 2007; 56: 239–244.
 Boelen A, Kwakkel J, Fliers E. Beyond low plasma T3: local thyroid hormone metabolism during inflammation and infection. Endocrine Reviews. 2011; 32: 670–693.
 Lodha R, Vivekanandhan S, Sarthi M, Arun S, Kabra SK. Thyroid function in children with sepsis and septic shock. Acta Paediatrica. 2007; 96: 406–409.
 Liu J, Wu X, Lu F, Zhao L, Shi L, Xu F. Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia. Scientific Reports. 2016; 6: 22271.
 Neamtu M, Dobrota L, Neamtu M, Neamtu CB, Diac F. 966 the nonthyroidal illness syndrome in septic children. Archives of Disease in Childhood. 2012; 97: A276.
 Angelousi AG, Karageorgopoulos DE, Kapaskelis AM, Falagas ME. Association between thyroid function tests at baseline and the outcome of patients with sepsis or septic shock: a systematic review. European Journal of Endocrinology. 2011; 164: 147–155.
 Peeters RP, Wouters PJ, van Toor H, Kaptein E, Visser TJ, Van den Berghe G. Serum 3,3′,5′-Triiodothyronine (rT3) and 3,5,3′-Triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. The Journal of Clinical Endocrinology & Metabolism. 2005; 90: 4559–4565.
 Slag MF, Morley JE, Elson MK, Crowson TW, Nuttall FQ, Shafer RB. Hypothyroxinemia in critically ill patients as a predictor of high mortality. The Journal of the American Medical Association. 1981; 245: 43–45.
 Huang DT, Weissfeld LA, Kellum JA, Yealy DM, Kong L, Martino M, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Annals of Emergency Medicine. 2008; 52: 48–58. e2.
 Boussekey N, Leroy O, Georges H, Devos P, d’Escrivan T, Guery B. Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit. Infection. 2005; 33: 257–263.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.