Ramazan ÇAKMAK, Adem ATICI, Murat BEKTAŞ, Timur AKPINAR, Murat KOSE, Gülden YÜRÜYEN, Oğuz Kağan BAKKALOĞLU, Tufan TÜKEK

ÖTİROİD HASTA SENDROMU: SEPSİSLİ YAŞLI HASTALARDA SIKLIĞI VE PROGNOZU

Amaç: Ötiroid hasta sendromu (ÖHS), serum serbest tiroid hormonlarının azalması ve tiroid stimülan hormonun normal veya azalmış sekresyonu ile kendini gösterir. Bu çalışmada, sepsisli yaşlı hastalarda ÖHS prevalansının belirlenmesi ve prognoz ve mortalite üzerindeki olası etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Sepsis tanısı alan 203 hasta prospektif olarak değerlendirildi. Hastalar geriatrik grup (≥65 yaş) ve kontrol grubu (<65 yaş) olarak iki gruba ayrıldı. Serbest T3 (sT3) ve/veya serbest T4 (sT4)’ü düşük olan hastalar ötiroid hasta sendromu olduğu kabul edildi. Hastaların demografik özellikleri, komorbiditeleri, laboratuvar sonuçları, hastaneye yatış verileri, yoğun bakım ünitesi (YBÜ) ihtiyacı ve kalış süreleri, tedavi sonuçları ve mortalite oranları kaydedildi ve karşılaştırıldı. Bulgular: Geriatrik grupta ÖHS insidansı anlamlı olarak daha yüksekti (%88,5 vs %77,8) (p=0,04). Gruplar arasında mortalite ve YBÜ ihtiyaçları açısından anlamlı fark saptanmadı. Bununla birlikte, tüm hastalarda ölen hastaların oranı %91,3 ve geriatrik gruptaki ölen hastaların ise tamamı ÖHS (+) hastalardı. Ölen hastalarda ve YBÜ hastalarında ortalama sT3 düzeyleri anlamlı olarak azalmıştı (p=0,017). Ek olarak, hem tüm grupta hem de geriatrik grupta azalmış sT4 seviyeleri mortalite ve yoğun bakım ihtiyaçları ile anlamlı olarak ilişkiliydi (p-değeri: sırasıyla 0,020 ve 0,019). Sonuç: Sepsisli yaşlı hastalarda ÖHS prevalansının (%88,5) daha yüksek olduğu açıkça gösterilmiştir. Ek olarak, ÖHS (+) grubunda yaklaşık iki kat daha yüksek mortalite ve YBÜ kalış riski belgelenmiştir. Bu nedenle, sepsisi olan yaşlı hastalarda ÖHS’nin basitçe taranması, tedavi kararlarına ve karmaşık klinik seyrin erken tahminine ve kötü prognozun belirlenmesine kesinlikle katkıda bulunacaktır.

Anahtar Kelimeler:

sepsis, ötiroid hasta sendromu, tiroid hormonları

EUTHYROID SICK SYNDROME: PREVALENCE AND PROGNOSIS IN ELDERLY PATIENTS WITH SEPSIS

Objective: Euthyroid sick syndrome (ESS) manifests by the decreased level of serum free thyroid hormones and with the normal or decreased secretion of thyroid-stimulating hormone. The study aims to identify the prevalence of ESS in elderly patients with sepsis and evaluate its possible effect on prognosis and mortality. Material and Methods: Two hundred and three patients diagnosed with sepsis were prospectively evaluated. They were divided into two groups, a geriatric group (≥65 years), and a control group (<65 years). Patients with low free T3 (fT3) and/or free T4 (fT4) were considered to have euthyroid-sick syndrome. The demographic characteristics, comorbidities, laboratory results, hospitalization data, intensive care unit (ICU) duration, treatment outcomes, and mortality rates of the patients were recorded and compared. Results: The incidence of ESS was significantly higher in the geriatric group (88.5% vs. 77.8%) (p=0.04). There was no difference between the groups in regard to mortality rate and ICU stay. However, 91.3% of deceased patients in the entire group and all deceased patients in the geriatric group were ESS (+) patients. The mean fT3 was significantly decreased in the deceased patients, and ICU patients (p=0.017). Additionally, the decreased levels of fT4 in both the entire group and the geriatric group were significantly associated with mortality and ICU stay (p-value: 0.020 and 0.019, respectively). Conclusions: The higher prevalence of ESS (88.5%) in elderly patients with sepsis was clearly demonstrated. Additionally, approximately two-fold higher mortality and ICU stay risk was documented in the ESS (+) group. Thus, simply screening of ESS in septic elderly patients will certainly contribute to treatment decisions and early prediction of complicated clinical course and poor prognosis.

Keywords:

sepsis, euthyroid sick syndrome, thyroid hormones,

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