Association of Hormonal Changes with Disease Severity and Mortality in Critically-ill Patients

ABSTRACT

Purpose: Endocrine and metabolic changes, which may affect the prognosis and outcome, can occur in critically ill patients. In this prospective study, we aimed to evaluate the changes in the pituitary-adrenal-gonadal-thyroid axis in patients admitted to the adult intensive care unit on admission and 15 days later and also to evaluate whether these hormonal changes contribute to prognosis and mortality as well as to investigate the association between these hormonal changes and Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores, length of hospitalization, and mortality.
Material and Method: One hundred and fifty seven patients were enrolled in this study. Severity of illness was assessed by APACHE II and SOFA scores. Blood samples were collected within the first 4 hours of intensive care unit admission and 15 days later for hormonal evaluation.
Results: Eighty-five patients were in survival (S), 72 were in the non-survival (NS) group. The median age, and baseline APACHE II, median APACHE II mortality and SOFA scores in NS group were significantly higher than in S group. According the baseline endocrine parameters, the predictive factors on mortality were age, baseline SOFA score and hospitalization length and also, 15 days after the admission, age and Δ TSH were found be the predictive factors in mortality.
Discussion: Our study revealed that none of the endocrine parameters contribute to mortality except Δ TSH. We assume that Δ TSH can be used together with APACHE II or SOFA scores in the prediction of prognosis in a tertiary mixed type intensive care unit.