Prevalence and prognostic value of euthyroid sick syndrome among critically ill children

Abstract

INTRODUCTION: Euthyroid sick syndrome (ESS) is the main endocrine abnormality observed in
critically ill patients. The presence and severity of ESS has been associated with a worse clinical course.
OBJECTIVE: To analyze the prevalence of ESS in critically ill children and its correlation with disease’s
severity and its clinical outcome.
MATERIAL AND METHODS: prospective, observational and analytical study in critically ill children of
the intensive care unit between May 2019 and May 2020. ESS was defined as the alteration in thyroid tests
in critical illness context and in the absence of pre-existing hypothalamic-pituitary-thyroid alterations.
Other variables analyzed were: age, sex, length of hospitalization, requirement for mechanical ventilation and/or inotropic, diagnosis at admission, PIM3. Chi square test was used for qualitative variables and
Wilcoxon test for quantitative variables.
RESULTS: Of the 47 patients studied, 28 (60%) presented ESS. No differences were observed between
sex (p>0,999), use of inotropics (p=0,1564) or deaths (p>0,999). Patients with ESS had a longer hospital
stay (p=0,0390) and required more invasive mechanical ventilation (p=0,0261). There was an association
between low levels of thyroid hormones and a higher coefficient and probability of mortality (p<0,0001
and p<0,001, respectively).
CONCLUSIONS: ESS is frequent in critically ill children and is mainly associated with two indicators of
severity: length of stay and invasive mechanical ventilation. The association between low levels of thyroid
hormones and high coefficients and probability of mortality turns the thyroid profile as an element to predict
the clinical evolution.