Non-Thyroidal Illness Syndrome in Critically Ill Children: Prognostic Value and Impact of Nutritional Management
| Autor: | Ilse Vanhorebeek, Sascha Verbruggen, angouche L, Koen F. M. Joosten, An Jacobs, E. van Puffelen, Inge Derese, Lies Pauwels, S Vander Perre, Patrick Wouters, Sören Verstraete, G Van den Berghe, G Garcia Guerra |
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| Přispěvatelé: | Pediatric Surgery, Pediatrics |
| Rok vydání: | 2019 |
| Předmět: |
Male
Parenteral Nutrition Pediatrics Time Factors endocrine system diseases Endocrinology Diabetes and Metabolism INFANTS Original Studies Alberta DOUBLE-BLIND 0302 clinical medicine Endocrinology Risk Factors Child Triiodothyronine Thyroid Age Factors TYPE-3 DEIODINASE 3. Good health Europe TRIIODOTHYRONINE nutrition Treatment Outcome medicine.anatomical_structure Child Preschool 030220 oncology & carcinogenesis Female Life Sciences & Biomedicine hormones hormone substitutes and hormone antagonists Thyroid Hormones endocrine system medicine.medical_specialty pediatrics Critical Illness Nutritional Status 030209 endocrinology & metabolism ENTERAL NUTRITION Intensive Care Units Pediatric Risk Assessment Time-to-Treatment Endocrinology & Metabolism 03 medical and health sciences medicine critical illness Humans prognostic value Intensive care medicine LATE PARENTERAL-NUTRITION PROLONGED CRITICAL ILLNESS Science & Technology PITUITARY-THYROID AXIS business.industry Critically ill Infant Euthyroid Sick Syndromes THYROTROPIN-RELEASING-HORMONE non-thyroidal illness syndrome Reverse t3 Critical illness business Value (mathematics) Biomarkers CARDIAC-SURGERY Hormone |
| Zdroj: | Thyroid, 29(4), 480-492. Mary Ann Liebert Inc. |
| ISSN: | 1557-9077 1050-7256 |
| Popis: | INTRODUCTION: Non-thyroidal illness (NTI), which occurs with fasting and in response to illness, is characterized by thyroid hormone inactivation with low triiodothyronine (T3) and high reverse T3 (rT3), followed by suppressed thyrotropin (TSH). Withholding supplemental parenteral nutrition early in pediatric critical illness (late-PN), thus accepting low/no macronutrient intake up to day 8 in the pediatric intensive care unit (PICU), accelerated recovery compared to initiating supplemental parenteral nutrition early (early-PN). Whether NTI is harmful or beneficial in pediatric critical illness and how it is affected by a macronutrient deficit remains unclear. This study investigated the prognostic value of NTI, the impact of late-PN on NTI, and whether such impact explains or counteracts the outcome benefit of late-PN in critically ill children. METHODS: This preplanned secondary analysis of the Early versus Late Parenteral Nutrition in the Pediatric Intensive Care Unit randomized controlled trial quantified serum TSH, total thyroxine (T4), T3, and rT3 concentrations in 982 patients upon PICU admission versus 64 matched healthy children and in 772 propensity score-matched early-PN and late-PN patients upon admission and at day 3 or last PICU day for shorter PICU stay. Associations between thyroid hormone concentrations upon admission and outcome, as well as impact of late-PN on NTI in relation with outcome, were assessed with univariable analyses and multivariable logistic regression, linear regression, or Cox proportional hazard analysis, adjusted for baseline risk factors. RESULTS: Upon PICU admission, critically ill children revealed lower TSH, T4, T3, and T3/rT3 and higher rT3 than healthy children (p |
| Databáze: | OpenAIRE |
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