Predictive value of thyroid hormones on the first day in adult respiratory distress syndrome patients admitted to ICU: comparison with SOFA and APACHE II scores

BACKGROUND: Thyroid hormone dysfunction could affect outcome and increase mortality in critical illness. Therefore, in a prospective, observational study we analyzed and compared the prognostic accuracy of free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), along with the APACHE II and SOFA scoring systems in predicting intensive care unit (ICU) mortality in critically ill patients. PATIENTS AND METHODS: Physiology scores were calculated for the first 24 hours after ICU admission in 206 patients with acute respiratory distress syndrome. APACHE II and SOFA scores were employed to determine the initial severity of illness. Thyroid hormones were measured within the first 24 hours. Logistic regression models were created for APACHE II scores, SOFA scores, and thyroid hormone levels. The models predicted high- and low-risk subgroups. Models that showed a good fit were stratified by Kaplan-Meier survival curves. RESULTS: There were 98 (47.6%) survivors and 108 (52.4%) non-survivors. The survivors had a lower APACHE II score (11.50 vs 15.82, P<0.0005), a lower SOFA score (6.06 vs 9.42, P<0.0005), a younger age (57 vs 70 years, P=0.008), a shorter ICU stay (13 vs 16 days, P=0.012), and a higher fT3 level (2.18 vs 1.72 pg/mL, P=0.002) than non-survivors. ICU survival was most closely predicted by a model that included age and fT3 and a model that included APACHE II and APACHE II*sex. CONCLUSION: In critically ill patients, serum fT3 concentrations markedly decreased after ICU admission among non-survivors. According to our findings, fT3 levels might have additive discriminatory power to age, SOFA and APACHE II scores in predicting short-term mortality in ARDS patients admitted to ICU.