Association between severity of sepsis and thyroid function profile

Vindy Nugraha Siampa; Satriawan Abadi; Andi Makbul Aman; Syakib Bakri; Risna Halim; Andi Alfian Zainuddin

doi:10.23750/abm.v94i6.15076

Association between severity of sepsis and thyroid function profile

Authors

Vindy Nugraha Siampa Department of Internal Medicine, Faculty of Medicine, Hasanuddin University https://orcid.org/0000-0002-3370-9855
Satriawan Abadi Department of Internal Medicine, Faculty of Medicine, Hasanuddin University https://orcid.org/0000-0002-0561-6467
Andi Makbul Aman Department of Internal Medicine, Faculty of Medicine, Hasanuddin University https://orcid.org/0000-0002-9342-4085
Syakib Bakri Department of Internal Medicine, Faculty of Medicine, Hasanuddin University https://orcid.org/0000-0002-6615-5166
Risna Halim Department of Internal Medicine, Faculty of Medicine, Hasanuddin University https://orcid.org/0000-0002-3847-8849
Andi Alfian Zainuddin Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University https://orcid.org/0000-0003-4436-3906

DOI: https://doi.org/10.23750/abm.v94i6.15076

Keywords:

Low-T3 Syndrome, thyroid, septic shock, sepsis

Abstract

Background and aim: Critical illness conditions such as sepsis are often accompanied by altered hormone levels, which may result in decreased thyroid axis activity. This condition aims to provide metabolic substrates for vital organs such as the brain and immune system. Significant alteration of the thyroid axis in critical illnesses such as sepsis known as Low-T3 Syndrome which is associated with increased mortality. This study aims to determine the association between severity of sepsis and thyroid function profile as a predictor of mortality in sepsis patients. Methods: An observational study involving 62 subjects with sepsis and septic shock. Serum was measured using Enzyme-linked Immunosorbent Assay (ELISA) method. Statistical analysis used Mann-Whitney, Kruskal-Wallis, and Spearman's correlation tests. Statistical test results are significant if the p-value <0.05. Results: The median fT3 level was lower in the septic shock group 13.94 pg/ml (7.71-19.93) compared to the sepsis group 20.15 pg/ml (11.08-37.15) where there was a significant difference (p<0.001). There was a significant correlation between The Sequential Organ Failure Assessment (SOFA) score and fT3 levels (R: -0.270, p=0.032). The non-survivor group had a lower median fT3 level 16.56 pg/ml (7.71-30.03) compared to the survivor group 17.50 pg/ml (10.32-37.15) where there was a significant difference (p<0.036). Conclusion: Based on the severity of sepsis, the more severe the sepsis condition, the lower thyroid function levels are obtained where decreased thyroid function levels can be a prognosis indicator to predict mortality in sepsis patients.

References

Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y.

1. Tambajong RN, Lalenoh DC, Kumaat L. Profil penderita sepsis di ICU RSUP Prof. Dr. R. D. Kandou Manadoperiode Desember 2014 â€“ November 2015. doi: 10.35790/ecl.v4i1.11011.

Purba AKR, Mariana N, Aliska G, et al. The burden and costs of sepsis and reimbursement of its treatment in a developing country: An observational study on focal infections in Indonesia. Int J Infect Dis. 2020;96:211-218. doi: https://doi.org/10.1016/j.ijid.2020.04.075.

Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. 2017; 318 (13): 1241 - 1249. doi: 10.1001/jama.2017.13836.

Widmer A, Schuetz P. Endocrine dysfunction during sepsis - are changes in hormone levels a physiological adaptation or a therapeutic target? J Lab Precis Med. 2018;3(61):1-6. doi: 10.21037/jlpm.2018.07.02.

Luo B, Yu Z, Li Y. Thyroid hormone disorders and sepsis. Biomed Mater Eng. 2017;28:S237-S241. doi: 10.3233/BME-171646.

Wasyluk W, Wasyluk M, Zwolak A. Sepsis as a pan‐endocrine illness - endocrine disorders in septic patients. J Clin Med. 2021;10:2075. doi: https://doi.org/10.3390/jcm10102075.

Cornu MG, Martinuzzi ALN, Roel P, et al. Incidence of low-triiodothyronine syndrome in patients with septic shock. Rev Bras Ter Intensiva. 2020;32(4):514-520. doi: 10.5935/0103-507X.20200088.

Pal A, Jain N, Patidar M. Study of Thyroid Profile in Patients with Sepsis. J Med Sci Clin Res. 2017;5(12):31514-31518. doi: https://dx.doi.org/10.18535/jmscr/v5i12.46.

Hosny M, Rashad R, Atef D, Abed N. Predictive value of thyroid hormone assessment in septic patients in comparison with C-reactive protein. Egypt J Crit Care Med. 2015;3(2-3):55-61. doi: http://dx.doi.org/10.1016/j.ejccm.2015.11.001.

Purwanto DS, Astrawinata DAW. Mekanisme Kompleks Sepsis dan Syok Septik. J Biomedik. 2018;10(3):143-151. doi: https://doi.org/10.35790/jbm.10.3.2018.21979.

Kim JG, Shin H, Kim W, et al. The Value of Decreased Thyroid Hormone for Predicting Mortality in Adult Septic Patients: A Systematic Review and Meta-analysis. Sci Rep. 2018;8(1):1-9. doi:10.1038/s41598-018-32543-7.

Mebis L, van den Berghe G. The hypothalamus-pituitary-thyroid axis in critical illness. Neth J Med. 2009;67(10):332-340. PMID: 19915227.

Mishra A, Saini R, Mittal M, Himanshu D, Gupta K, Mahdi A. Prognostic efficacy of thyroid profile with sequential organ failure assessment score in predicting mortality in intensive care unit patients. Thyroid Res Pract. 2019;16(3):113-120. doi: 10.4103/trp.trp_17_19.

Fliers E, Bianco AC, Langouche L, Boelen A. Endocrine and metabolic considerations in critically ill patients. Lancet Diabetes Endocrinol. 2015;3(10):816-825. doi:10.1016/S2213-8587(15)00225-9.

Zhang JG, Fu SM, Liu F, et al. Correlation and Prognostic Assessment of Low T3 Syndrome and Norepinephrine Dosage for Patients with Sepsis: A Retrospective Single-Center (Cohort) Study. Int J Gen Med. 2022;15(April):4837-4847. doi: https://doi.org/10.2147/IJGM.S362748.

Singer Mervyn, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA - J Am Med Assoc. 2016;315(8):801-810. doi:10.1001/jama.2016.0287.

Foks M, Dudek A, Polok K, Nowak-Kózka I, Fronczek J, Szczeklik W. Thyroid hormones as potential prognostic factors in sepsis. Anaesthesiol Intensive Ther. 2019;51(3):205-209. doi: https://doi.org/10.5114/ait.2019.86883.

Gustot T. Multiple organ failure in sepsis: Prognosis and role of systemic inflammatory response. Curr Opin Crit Care. 2011;17(2):153-159. doi: 10.1097/MCC.0b013e328344b446.

Chen Y, Chang J, Yin R, et al. Diagnosis and treatment of low T3 syndrome in neurocritical patients. J Clin Pharm Ther. 2020;45(4):759-766. doi: 10.1111/jcpt.13162.

Moura Neto A, Zantut-Wittmann DE. Abnormalities of Thyroid Hormone Metabolism during Systemic Illness: The Low T3 Syndrome in Different Clinical Settings. Int J Endocrinol. 2016;2016. doi: http://dx.doi.org/10.1155/2016/2157583.