RT Journal Article
SR Electronic
T1 Low-t3 state a crucial biomarker in determining NIV failure and outcome in pulmonary patient?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP p5008
VO 38
IS Suppl 55
A1 Elvio Scoscia
A1 Stefano Baglioni
A1 Elisabetta Fiandra
A1 Maurizio Dottorini
A1 Oronzo Penza
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/p5008.abstract
AB Background: Various low T3 states have been described in severe nonthyroidal diseases; they have been associated with a poor prognosis in cardiovascular and pulmonary disease patients.Aim: We assessed thyroid function in patients suffering from respiratory failure (RF), needing invasive or non-invasive mechanical ventilation (NIV), in order to evaluate the prognostic value of nonthyroidal illness syndrome in NIV failure.Methods: We studied retrospectively 32 consecutive patients with acute or acute on chronic RF needing mechanical ventilation. Measured variables upon admission included: APACHE II score, the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in inspired gas (PaO2/FiO2), plasma levels of freeT3 (fT3), freeT4 (fT4), and Thyroid Stimulating Hormone (TSH) levels.Results: Plasma levels of fT3 were below normal range in 17 patients (53%). Plasma fT3 correlated with PaO2/FiO2 (p<0.001), and with APACHE II score (p=0.003).Ten patients with low levels of fT3 needed invasive mechanical ventilation due to NIV failure. These patients, with comparable APACHE II score and gas exchange, showed fT3 value significantly lower than patients improving with NIV.FT3 levels were significantly lower (p=0.002) in four patients (12.5%) who died, in comparison to the patients who survived. FT3 value was the only factor significantly associated with an increased risk of death, according univariate logistic regression analysis (Odds Ratio 64.23, 95% Confidence Interval 1.78 to 2316.86, p=0.023).Conclusion: Our data suggest that low T3 state can predict NIV failure and outcome in pulmonary patients with acute RF.