Higher caloric exposure in critically ill patients transiently accelerates thyroid hormone activation.
Higher caloric exposure in critically ill patients transiently accelerates thyroid hormone activation.
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DOI：
10.1210/clinem/dgz077
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发表时间：
2020-02
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通讯作者：
L. McKeever;S. Peterson;Omar B. Lateef;S. Freels;Tatiana L Fonseca;Barbara M.L.C. Bocco;G. W. Fernandes;K. Roehl;Kristen Nowak;M. Mozer;A. Bianco;C. Braunschweig
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作者：
L. McKeever;S. Peterson;Omar B. Lateef;S. Freels;Tatiana L Fonseca;Barbara M.L.C. Bocco;G. W. Fernandes;K. Roehl;Kristen Nowak;M. Mozer;A. Bianco;C. Braunschweig
前言危重病的炎症反应伴随着非甲状腺疾病综合征（NTIS）。喂养已被证明可以减弱这一过程，但尚未在重症患者中随着时间的推移对这一点进行前瞻性探索。目的探讨热量暴露对危重患者NTIS随时间变化的影响。方法机械通气全身炎症反应综合征（SIRS）患者随机接受100%或40%的估计热量需求（分别为100%ECN和40%ECN）。每天测量甲状腺激素，持续7天或直到重症监护室出院或死亡。采用混合水平回归模型探讨随机分组对血浆T3/rT 3比值以及T3、rT 3、T4和TSH的影响。结果共招募了35名参与者（100%ECN中19名，40%ECN中16名）。调整基线T3/rT 3比值的组间差异后，定义拟合曲线的参数（截距、研究日的线性效应和研究日的二次效应）因随机分组而异（分别为p=0.001、p=0.01和p=0.02）。拟合曲线图显示，与40%ECN组相比，100%ECN组的参与者在干预后第1天的T3/rT 3比值高出54%，这种差异随着时间的推移而减弱。这是由干预后1的血浆T3水平升高23%和血浆rT 3水平降低10%驱动的。结论：NTIS患者的高热量暴露可暂时减弱血浆T3/rT 3比值的下降，这种效应在接下来的3天持续高热量暴露中最小化并最终消失。
INTRODUCTION The inflammatory response of critical illness is accompanied by non-thyroidal illness syndrome (NTIS). Feeding has been shown to attenuate this process, but this has not been explored prospectively over time in critically ill patients. OBJECTIVE To explore the impact of calorie exposure on NTIS over time in critically ill patients. METHODS Mechanically ventilated systemic inflammatory response syndrome (SIRS) patients were randomized to receive either 100% or 40% of their estimated caloric needs (100% ECN vs 40% ECN respectively). Thyroid hormones were measured daily for 7 days or until intensive care unit discharge or death. Mixed level regression modeling was used to explore the effect of randomization group on the plasma T3/rT3 ratio as well as T3, rT3, T4, and TSH. RESULTS Thirty-five participants (19 in 100% ECN, 16 in 40% ECN) were recruited. Adjusting for group differences in baseline T3/rT3 ratio, the parameters defining the fitted curves (intercept, linear effect of study day and quadratic effect of study day) differed by randomization group (p=0.001, p=0.01, and p=0.02 respectively). Plots of the fitted curves revealed participants in the 100% ECN group had a 54% higher T3/rT3 ratio on post-intervention day 1 compared to the 40% ECN group, a difference which attenuated over time. This was driven by a 23% higher plasma T3 and 10% lower plasma rT3 levels on post-intervention 1. CONCLUSIONS Higher caloric exposure in NTIS patients transiently attenuates the drop of the plasma T3/rT3 ratio, an effect that is minimized and finally lost over the next 3 days of continued higher caloric exposure.