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Distinct Features of Nonthyroidal Illness in Critically Ill Patients With Infectious Diseases

 Woo Kyung Lee  ;  Sena Hwang  ;  Daham Kim  ;  Seul Gi Lee  ;  Seonhyang Jeong  ;  Mi-Youn Seol  ;  Hyunji Kim  ;  Cheol Ryong Ku  ;  Dong Yeop Shin  ;  Woong Youn Chung  ;  Eun Jig Lee  ;  Jandee Lee  ;  Young Suk Jo 
 MEDICINE, Vol.95(14) : 3346, 2016 
Journal Title
Issue Date
Aged ; Critical Illness ; Female ; Humans ; Infection/complications* ; Inflammation/complications* ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Thyroid Gland
Nonthyroidal illness (NTI), often observed in critically ill patients, arises through diverse alterations in the hypothalamus-pituitary-thyroid (HPT) axis. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood.The aim of this study was to examine NTI severity and adverse outcomes in critically ill patients with respect to their underlying disease(s).The medical records of 616 patients admitted to the intensive care unit (ICU) between January 2009 and October 2014 were retrospectively reviewed. Patients with known diseases or taking medications that affect thyroid function were excluded. All-cause mortality (ACM) and length of stay (LOS) in the ICU were assessed as adverse outcomes.The enrolled patients (n = 213) were divided into the following 4 groups according to the severity of NTI at the nadir of their thyroid function test (TFT): normal (n = 11, 5.2%), mild NTI (n = 113, 53.1%), moderate NTI (n = 78, 36.6%), and severe NTI (n = 11, 5.2%). There was no significant difference between the groups in terms of age and gender. NTI severity showed a significantly strong association with ACM (P < 0.0001) and a significant positive association with LOS in the ICU (P = 0.031). After adjusting for age, gender, and current medications affecting TFT, increasing NTI severity led to increased ACM (odds ratio = 3.101; 95% confidence interval = 1.711-5.618; P < 0.0001). Notably, the prevalence of moderate-to-severe NTI was markedly higher in patients with infectious disease than in those with noninfectious disease (P = 0.012). Consistent with this, serum C-reactive protein levels were higher in patients with moderate-to-severe NTI (P = 0.016).NTI severity is associated with increased ACM, LOS, and underlying infectious disease. Future studies will focus on the biological and clinical implications of infectious disease on the HPT axis.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Ku, Cheol Ryong(구철룡) ORCID logo https://orcid.org/0000-0001-8693-9630
Kim, Daham(김다함) ORCID logo https://orcid.org/0000-0003-1871-686X
Shin, Dong Yeob(신동엽) ORCID logo https://orcid.org/0000-0003-1048-7978
Lee, Seul Gi(이슬기) ORCID logo https://orcid.org/0000-0003-3233-7823
Lee, Woo Kyung(이우경) ORCID logo https://orcid.org/0000-0002-6737-3173
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Lee, Jan Dee(이잔디) ORCID logo https://orcid.org/0000-0003-4090-0049
Jeong, Seonhyang(정선향) ORCID logo https://orcid.org/0000-0002-5549-9182
Chung, Woung Youn(정웅윤)
Jo, Young Suk(조영석) ORCID logo https://orcid.org/0000-0001-9926-8389
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