The predictive values of thyroid hormone and inflammatory mediators on prognosis in patients with systemic inflammatory response syndrome / 中国中西医结合急救杂志

ABSTRACT

Objective To explore the predictive values of the levels of procalcitonin (PCT) and thyroid hormone on the prognosis in patients with systemic inflammatory response syndrome (SIRS) complicated with euthyroid sick syndrome (ESS) and their values on differential diagnosis of ESS. Methods A total of 238 patients with SIRS hospitalized in the Emergency Department, Jiangsu Provincial Hospital of Integration of Chinese and Western Medicine, Jiangsu Branch of China Academy of Chinese Medical Sciences from July 2012 to December 2014 were divided into two groups death group (31 cases) and survival group (207 cases), 182 patients being complicated with ESS and 56 patients without ESS. The differences in the levels of PCT, free triiodothyronine (FT3) and acute physiology and chronic health evaluation (APACHE Ⅱ) score in patients with different clinical outcomes were analyzed. The effects of the inflammatory mediators including levels of PCT, interleukin-6 (IL-6), C-reactive protein (CRP), and thyroid function such as free thyroxine (FT4) and thyroid stimulating hormone (TSH) on clinical outcomes and their predictive values on death of emergency patients with SIRS were also studied. Furthermore, the correlations between APACHEⅡscore and PCT, IL-6, CRP, thyroid hormone were analyzed. Results The level of PCT and APACHE Ⅱ score in death group were significantly higher than those in survival group [PCT (ng/L) 8.38 (13.88) vs. 1.04 (3.57), APACHEⅡscore27.42±6.88 vs. 16.35±6.72, both P0.05). The mortality was increased markedly in patients with higher PTC level and lower FT3 level compared with normal PCT level and normal FT3 level [18.8% (30/160) vs. 1.3% (1/78), 17.1%(31/181) vs. 0 (0/57), both P0.05). PCT was positively correlated with APACHEⅡscore (r>0.33, P<0.001), while FT3 was negatively correlated with APACHEⅡscore (r<-0.33, P<0.001). There were no correlations between IL-6 (r = 0.319, P < 0.001), CRP (r = 0.161, P < 0.05), FT4 (r = -0.170, P < 0.01), TSH (r = -0.057, P = 0.385), and APACHEⅡscore. The levels of PCT, IL-6 and CRP and APACHEⅡscore in patients with ESS were significantly higher than those in patients without ESS [PCT (ng/L)2.54 (5.90) vs. 0.20 (0.43), IL-6 (ng/L)98.62 (351.20) vs. 16.85 (33.60), CRP (mg/L)88.00 (110.50) vs. 25.50 (48.00), APACHEⅡscore17.62±8.17 vs. 10.98±4.97, all P<0.01]. The cut-off values for predicting patient's death of these indexes showed by receiver operating characteristic curve (ROC curve) analysis were as follows PCT cut-off value ≥ 1.755 ng/L, sensitivity 87.1%, specificity 58.0%, area under the ROC curve (AUC) 0.802; FT3 cut-off value ≤ 2.92 pmol/L, sensitivity 93.5%, specificity 54.1%, AUC 0.785;APACHE Ⅱ score cut-off value ≥ 21.5, sensitivity 83.9%, specificity 88.4%, AUC 0.920. Conclusions The levels of serum PCT, FT3 and APACHEⅡscore are prognostic factors in patients with SIRS. Meanwhile, the levels of serum PCT, IL-6, CRP and APACHE Ⅱ score should be taken into consideration in differential diagnosis of ESS in patients with SIRS.