Comparison of Predictive Indices of Severity Scorings, Metabolism, and Thyroid Hormones in Systemic Inflammatory Reaction Syndrome.

Lee,  Young Joo; Chung,  Sung Mee; Hong,  Jeong Sook; Moon,  Bong Ki; Wang,  Hee Jung; Lee,  Young Seok

doi:1999.37.5.799

Clinical Research Article

Korean Journal of Anesthesiology 1999;37(5):799-806.
DOI: https://doi.org/10.4097/kjae.1999.37.5.799

Comparison of Predictive Indices of Severity Scorings, Metabolism, and Thyroid Hormones in Systemic Inflammatory Reaction Syndrome.

Young Joo Lee, Sung Mee Chung, Jeong Sook Hong, Bong Ki Moon, Hee Jung Wang, Young Seok Lee

¹Department of Anesthesiology, Ajou University School of Medicine, Suwon, Korea.
²Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
³Department of Anesthesiology, Sungkunkwan University, Samsung Medical Center, Seoul, Korea.

Abstract

BACKGROUND
Systemic inflammatory reaction syndrome (SIRS) describes the systemic inflammatory process and can be seen following a wide variety of insults. This is the leading cause of morbidity and mortality for patients admitted to the ICU. The arterial keton body ratio (AKBR), serum lactate level and the thyroid hormones, thyroid stimulation hormone (TSH), thyroxine (T4), free thyroxine (FT4) and triiodothyronine (T3) deteriorate in critically ill patients with a poor prognosis. The APACHE (Acute Physiology, and Chronic Health Evaluation) III and multiple organ failure (MOF) score have been known as good prognostic predictors in the ICU. The object of this study was to compare the AKBR, lactate and thyroid hormone levels, and the APACHE III and MOF score between the survivors (SV) and nonsurvivors (NSV) and the correlation among the above predictors.
METHODS
35 patients with no known thyroid or liver disease who were admitted to the SICU with the criteria of SIRS were selected. Arterial blood was drawn for the AKBR, and the lactate and thyroid hormones studies. The APACHE III and MOF scorings were done in the first 24 hours of SICU admission.
RESULTS
There were no significant difference between SV and NSV except APACHE III (SV: 68.7 24.6, NSV; 92.9 27.6). There were significant correlations between the APACHE III and MOF score (R = 0.688, P<0.01), APACHE III and lactate (R = 0.575, P<0.01), and MOF score and lactate (R =0.483, P<0.01). Thyroid hormones had positive correlations among themselves only.
CONCLUSIONS
We conclude that APACHE III is the only good predictor of mortality. The APACHE III, MOF score, and lactate level show good correlations indicating the severity in condition of the ICU patients.

Key Words: Hormones, thyroid hormone; Measurement techniques, severity scorings, APACHE III, multiple organ failure; Metabolism, arterial keton body ratio, arterial lactate level.