Uloga hormona tiroidne žlezde u proceni preživljavanja bolesnika u odeljenjima intenzivne nege
Sažetak
Uvod/Cilj. Bolesnici u odeljenjima intenzivne nege (OIN) često imaju poremećaj u koncentraciji tiroidnih hormona (TH), čak i u slučajevima kada nisu prethodno imali poremećaj funkcije tiroidne žlezde. Cilj rada bio je da se utvrdi da li postoji korelacija između TH i stepena preživljavanja u OIN, kao i da li ovi hormoni imaju prediktivni značaj u proceni smrtnosti bolesnika. Metode. U studiji je učestvovalo 41 bolesnika (23 žene i 18 muškaraca) koji su bili podeljeni u dve grupe: grupu preživelih (70.7%) i grupu preminulih (29.3%). U uzorcima periferne krvi koji su uzimani u toku prva 24 sata od prijema u OIN određivani su nivoi TH: trijodtironin (T3), tiroksin (T4), slobodan T3 (free T3 – FT3), slobodan T4 (FT4) i tiroid-stimulirajući hormon (TSH), kao i prokalcitonin (PCT). Za svakog bolesnika izračunat je Sequential Organ Failure Assessment Score (SOFAS). Rezultati. Statistički značajna razlika između ispitivanih grupa (preživeli vs. preminuli, p < 0,05) utvrđena je za parametre SOFAS, T3, T4 i FT4. Površina ispod receiver operating characteristic (ROC) krive [area under the ROC curve (AUC) – (AUROC)] iznosila je za SOFAS 0,991 [95% confidence interval (CI): 0,898–1,000, p < 0,001], za T3 0,727 (95% CI: 0,566–0,854, p = 0,0097), za T4 0,793 (95% CI: 0,638–0,903, p = 0,0008), za FT3 0,707 (95% CI: 0,544–0,8389, p = 0,0299) i za FT4 0,795 (95% CI: 0,640–0,904, p = 0,0005). U poređenju sa ostalim parametrima, T3 je imao višu osetljivost (91,67%), FT4 višu specifičnost (93,10%), dok je SOFAS imao istovremeno i najvišu osetljivost (91,67%) i specifičnost (96,55%) u odnosu na sve druge ispitivane parametre. Primenom multiple linearne regresione analize utvrđeno je da su FT4 i T4 bili značajni prediktori vremena preživljavanja bolesnika (β = -0,362, p = 0,012 i β = -0,356, p = 0,014, redom). Zaključak. Među svim ispitanim TH, pokazano je da FT4 i T4 imaju snažan prediktivni potencijal za procenu smrtnosti bolesnika u OIN. Ovom studijom je istaknut značaj određivanja nivoa TH kod kritično obolelih, što je ključno jer otvara mogućnost primene specifičnh terapija koje bi korigovale poremećaje nastale zbog deficita hormona.
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