Thyroid hormone levels improve the prediction of mortality among patients admitted to the intensive care unit

• Published in: Intensive care medicine Vol. 31; no. 10; pp. 1356 - 1361
• Main Authors: CHINGA-ALAYO, Erick, VILLENA, Jaime, EVANS, Arthur T, ZIMIC, Mirko
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-10-2005; Berlin Springer Nature B.V
• Subjects: Analysis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Chronic diseases; Clinical death. Palliative care. Organ gift and preservation; Critically ill; Diagnosis; Female; Growth hormones; Health aspects; Hospital Mortality; Hospitals; Humans; Intensive care; Intensive care medicine; Intensive Care Units; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Male; Medical sciences; Middle Aged; Mortality; Physiology; Predictive Value of Tests; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; ROC Curve; Survival Analysis; Thyroid gland; Thyroid hormones; Thyroid Hormones - blood; United States; United States; Human; Intensive care; Survivor; Mortality; Acute Physiology and Chronic Health Evaluation; Thyroid stimulating hormone; Intensive care unit; Chronic; Thyroid-stimulating hormone; Adenohypophyseal hormone; Thyroid hormone; ICU survivors; Triiodothyronine; Resuscitation; Mortality prediction
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-005-2719-9

As hormones are strongly associated with mortality in critically ill patients, we investigated whether mortality prediction based on the Acute Physiology and Chronic Health Evaluation (APACHE) is improved by combining this score with hormone measurements.
Intensive care units in three hospitals.
113 patients admitted to.
Within the first hour after ICU admission we measured total triiodothyronine, total thyroxine, free thyroxine, thyrotropin, cortisol, growth hormone, dehydroepiandrosterone, and prolactin levels and administered the APACHE. Patients were followed until they died or were discharged from the ICU.
The best logistic regression model for ICU mortality included the APACHE score and thyroid-stimulating hormone and triiodothyronine levels. This model had an area under the receiver operating characteristic curve of 0.88, significantly higher than the APACHE score alone with 0.75. The model with hormone levels and APACHE score was also significantly better calibrated than the model with only the APACHE score.
The addition of thyroid hormones to the APACHE score improves the prediction of mortality for ICU patients.