Serum Reverse Triiodothyronine (rT3) And Triiodothyronine (T3) As Determinants For Outcome Of Geriatric Blunt Trauma Patients Admitted To ICU
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This study was designed to evaluate serum concentrations of thyroid hormones in patients in critical settings and to evaluate their association with the patient outcome as regards the morbidity and mortality. Patients and Methods : The study included 40 blunt trauma patients (32 nudes and 8 females) within the age range of 60-82 years. All patients underwent clinical evaluation using the Injury Severity Score (155) and blood samples were collected at admission to ICU (SI) and every 24 hours for 7 days (DI-Dr) for estimation of serum levels of triiodothyronine (1 5), tetraiodothyronine (T4), thyroid stimulating hormone (TSH) and reverse triiodothyronthe (rT3 ). Patients were .followed up at ICU for either discharge, development of additional morbidity or death. Results : Twenty-six patients had I55<25, 12 had ISS=25-<50 and only 2 patients had 155>50; 22 patients underwent surgical exploration and completed their postoperative care at ICU (Group A) and 18 patients were admitted for conservative treatment and follow-up at ICU, (Group B). Twenty-one (52.5%) patients; 15 and 6 in both groups, respectively, had no additional morbidity and were discharged; whereas 7 in group A and 12 in group B developed additional morbidity. Five patients in group A and 8 patients in group B had died with mortality rate of 32.5%. There was a negative significant correlation between patients' 155 at admission and occurrence of additional morbidity during follow-up (r=-0.622, p<0.001) and survival rate (r=-0.615, p<0.001). There was a progressive significant (p<0.05) decrease of serum Ti since D2 to D6 compared to baseline levels and especially in patients who developed additional morbidity compared to those who did not and in nonsumivors compared to survivors. Also, there was a positive significant correlation between serum Ti mid survival (r=0.628, p<0.001) and with the absence of occurrence of additional morbidity during observation period 0=0.676, p<0.001). Moreover, serum T3?-1.57 innol/L at admission could define the survivors with sensitivity 84.2%, specificity 81% and accuracy rate of 82.5%. On contrary; serum rT3 concentration was significantly (p<0.05) increased at D3-0, especially in those required conservative treatment compared to those underwent surgery and in patients who developed additional morbidity compared to those who did-not and in non-survivors compared to survivors. There was a positive significant correlation between serum rT3 and mean 155 score (r=0.459, p=0.003) and a negative significant correlation with the absence of occurrence of additional morbidity during observation period (r = -0.363, p=0.022). Furthermore, serum rT3 ..>4 0.415 muol/L at admission could &Jodi& cases that will develop additional morbidity with sensitivity 89.5%, specificity 90.5% and accuracy rate of 90%. Serum TSH started to increase significantly (p<0.05) D2 after admission and still increasing significantly (p<0.05) till DI and non-significantly thereafter.