Triiodothyronine hormone supplementation therapy in septic shock patients with euthyroid sick syndrome: A two pilot, placebo-controlled, randomized trials.
Euthyroid sick syndrome
Septic shock
Triiodothyronine supplementation
Journal
Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401
Informations de publication
Date de publication:
05 Dec 2023
05 Dec 2023
Historique:
received:
28
09
2023
revised:
29
11
2023
accepted:
30
11
2023
medline:
8
12
2023
pubmed:
8
12
2023
entrez:
7
12
2023
Statut:
aheadofprint
Résumé
To assess 28-day survival in two pilot groups of septic shock patients with euthyroid sick syndrome (ESS) supplemented with triiodothyronine (T3). A total of 95 septic shock patients with ESS were divided according to values of the thyroid hormones into low T3 and low T3T4 groups. Among 48 patients with low T3, 24 (50%) were randomized to T3 for 4 days and 24 (50%) to placebo. Among 47 patients with low T3T4, 24 (51%) were randomized to T3 for 4 days and 23 (49%) to placebo. The analysis included 28-day survival as the primary outcome and laboratory with hemodynamics as the secondary outcome. Laboratory data were analyzed on the day of admission (t0), on the first (t1), third (T2) and seventh day (t3) with hemodynamics analyzed for the first four days. In the low T3 population, 18 (75%) patients receiving T3 died at day 28 compared with 8 (33.3%) patients receiving placebo (p = 0.004). In the low T3T4 population, 6 (25%) patients receiving T3 died in ICU compared with 12 (52.1%) patients receiving placebo (p = 0.039). Oral T3 treatment increased mean arterial pressure values at day 1, day 3 and day 7 in the low T3T4 population, (p = 0.015, =0.005 and =0.042 respectively), and had no significant effect on these values in the low T3 population. T3 supplementation was associated with a low 28-day mortality rate in patients with low T3T4 but with increased mortality in patients with low T3 ESS. These results suggest caution before initiating thyroid supplementation in septic patients. ClinTrials.gov (NCT05270798).
Sections du résumé
BACKGROUND
BACKGROUND
To assess 28-day survival in two pilot groups of septic shock patients with euthyroid sick syndrome (ESS) supplemented with triiodothyronine (T3).
METHODS
METHODS
A total of 95 septic shock patients with ESS were divided according to values of the thyroid hormones into low T3 and low T3T4 groups. Among 48 patients with low T3, 24 (50%) were randomized to T3 for 4 days and 24 (50%) to placebo. Among 47 patients with low T3T4, 24 (51%) were randomized to T3 for 4 days and 23 (49%) to placebo. The analysis included 28-day survival as the primary outcome and laboratory with hemodynamics as the secondary outcome. Laboratory data were analyzed on the day of admission (t0), on the first (t1), third (T2) and seventh day (t3) with hemodynamics analyzed for the first four days.
RESULTS
RESULTS
In the low T3 population, 18 (75%) patients receiving T3 died at day 28 compared with 8 (33.3%) patients receiving placebo (p = 0.004). In the low T3T4 population, 6 (25%) patients receiving T3 died in ICU compared with 12 (52.1%) patients receiving placebo (p = 0.039). Oral T3 treatment increased mean arterial pressure values at day 1, day 3 and day 7 in the low T3T4 population, (p = 0.015, =0.005 and =0.042 respectively), and had no significant effect on these values in the low T3 population.
CONCLUSION
CONCLUSIONS
T3 supplementation was associated with a low 28-day mortality rate in patients with low T3T4 but with increased mortality in patients with low T3 ESS. These results suggest caution before initiating thyroid supplementation in septic patients.
REGISTRATION
BACKGROUND
ClinTrials.gov (NCT05270798).
Identifiants
pubmed: 38061681
pii: S2352-5568(23)00144-3
doi: 10.1016/j.accpm.2023.101336
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT05270798']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
101336Informations de copyright
Copyright © 2023. Published by Elsevier Masson SAS.