Prognostic significance of non-thyroidal illness syndrome in sepsis and septic shock cases: a systematic review and meta-analysis

  • Rio Wironegoro
  • Nabila Ananda Kloping
  • Andro Pramana Witarto
  • David Nugraha
  • Niwanda Yogiswara
  • Kevin Luke
  • Yudhistira Pradnyan Kloping
  • Maulydia Maulydia
  • Soebagijo Adi
Keywords: Non-thyroidal illness syndrome, Euthyroid sick syndrome, Sepsis, Septic shock, Prognosis

Abstract

Background: This study aimed to assess non-thyroidal illness syndrome (NTIS) as a prognostic determinant in patients with sepsis, severe sepsis, and septic shock by evaluating thyroid hormone (TH) levels.

Methodology: A systematic search was performed through electronic databases including PubMed, Embase, Scopus, and Medline. Following medical subject headings (MeSH) and free-text terms: "euthyroid sick syndrome" or "Euthyroid Sick Syndromes" or "non–thyroidal illness syndrome" or "non–thyroidal illness syndrome" or "sick euthyroid syndrome" or "low T3 syndrome" or "low tri-iodothyronine syndrome" AND "sepsis" or "septic shock" or "systemic inflammatory response syndrome" or "septicemia" or "bacteremia". Boolean operators’ combinations were applied to broaden and narrow the search results. Investigators independently reviewed the search results. For the purpose of the meta-analysis each thyroid hormone level was converted into the same unit: nmol/L for T3, T4 and rT3; μIU/mL for TSH; and pmol/L for fT3 and fT4. Statistical analysis was performed using Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.

Results: A total of 843 patients from 9 studies were included in this analysis. In septic patients, the lowest effect size of thyroid function parameter was TSH (g = 2.05; 95% CI = 1.56-2.54), while T3, fT3, and fT4 had the lowest effect size in severe septic patients (g [95%CI]: 0.83 [0.22-1.44]; 1.92 [0.57-3.27]; 1.00 [0.87-1.13]). Patients with septic shock had the highest effect size of TSH (g = 2.08; 95% CI = 1.54-2.61) and fT4 (g = 9.26; 95% CI = 0.98-17.53). Meanwhile, the lowest was T4 (g = 65.60; 95% CI = 64.63-66.57) and rT3 (g = 0.29; 95% CI = 0.24-0.34). A lower effect size of T3 (g = 0.83; 95% CI = 0.76-0.91), T4 (g = 59.48; 95% CI = 57.92-61.04), fT3 (g = 2.25; 95% CI = 1.83-2.66), and fT4 (g = 9.19; 95% CI = 1.56-16.81) were found in non-survivor groups.

Conclusion: Thyroid hormone levels differ according to the severity of sepsis in septic patients. Non-thyroidal illness syndrome is a prognostic factor in septic patients and is associated with the risk of the mortality.

Abbreviations: ESS - Euthyroid Sick Syndrome; NTIS - Non-Thyroidal Illness Syndrome; Tg - Thyroglobulin

Key words: Non-thyroidal illness syndrome; Euthyroid sick syndrome; Sepsis; Septic shock; Prognosis

Citation: Wironegoro R, Kloping NA, Witarto AP, Nugraha D, Yogiswara N, Luke K, KlopingYP, Maulydia M, Adi S. Prognostic significance of non-thyroidal illness syndrome in sepsis and septic shock cases: a systematic review and meta-analysis. Anaesth. pain intensive care 2021;26(1):54-62.

DOI: 10.35975/apic.v26i1.1768

Received: July 16, 2021, Reviewed: December 15, 2021, Accepted: December 28, 2021

Author Biographies

Rio Wironegoro

Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Nabila Ananda Kloping

Faculty of Medicine,Universitas Airlangga, Surabaya, Indonesia.

Andro Pramana Witarto

Faculty of Medicine,Universitas Airlangga, Surabaya, Indonesia.

David Nugraha

Faculty of Medicine,Universitas Airlangga, Surabaya, Indonesia.

Niwanda Yogiswara

Faculty of Medicine,Universitas Airlangga, Surabaya, Indonesia.

Kevin Luke

Faculty of Medicine,Universitas Airlangga, Surabaya, Indonesia.

Yudhistira Pradnyan Kloping

Faculty of Medicine,Universitas Airlangga, Surabaya, Indonesia.

Maulydia Maulydia

Department of Anaesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 

Soebagijo Adi

Department of Internal Medicine, Division of Endocrinology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Published
07-02-2022
How to Cite
Wironegoro, R., Kloping, N., Witarto, A., Nugraha, D., Yogiswara, N., Luke, K., Kloping, Y., Maulydia, M., & Adi, S. (2022). Prognostic significance of non-thyroidal illness syndrome in sepsis and septic shock cases: a systematic review and meta-analysis. Anaesthesia, Pain & Intensive Care, 26(1), 54-62. https://doi.org/10.35975/apic.v26i1.1768
Section
ORIGINAL RESEARCH

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