Effect of Tight Glucose Control with Insulin on the Thyroid Axis of Critically Ill Children and Its Relation with Outcome
Open accessAbstract
CONTEXT: Tight glucose control (TGC) to normal-for-age fasting blood glucose levels reduced morbidity and mortality in surgical adult and pediatric intensive care unit (ICU) patients. In adults, TGC did not affect the illness-induced alterations in thyroid hormones. With better feeding in children than in adult patients, we hypothesized that TGC in pediatric ICU patients reactivates the thyroid axis. OBJECTIVE: The aim of this study was to assess the impact of TGC on the thyroid axis in pediatric ICU patients and to investigate how these changes affect the TGC outcome benefit. DESIGN AND PATIENTS: We conducted a preplanned analysis of all patients not treated with thyroid hormone, dopamine, or corticosteroids who were included in a randomized controlled trial on TGC (n=700). MAIN OUTCOME MEASURES: Serum TSH, T4, T3, and rT3 were measured upon admission and on ICU day 3 or the last ICU day for patients discharged earlier. Changes from baseline were compared for the TGC and usual care groups. The impact on the outcome benefit of TGC was assessed with multivariable Cox proportional hazard analysis, correcting for baseline risk factors. RESULTS: TGC further lowered the T)/rT3 ratio (P=0.03), whereas TSH (P=0.09) and T4 (P=0.3) were unaltered. With TGC, the likelihood of earlier live discharge from the ICU was 19% higher at any time (hazard ratio, 1.190; 95% confidence interval, 1.010-1.407; P=0.03). This benefit was statistically explained by the further reduction of T3/rT3 with TGC because an increase in T3/rT3 was strongly associated with a lower likelihood for earlier live discharge (hazard ratio per unit increase, 0.863; 95% confidence interval, 0.806-0.927; P<0.0001). CONCLUSIONS: TGC further accentuated the peripheral inactivation of thyroid hormone. This effect, mimicking a fasting response, statistically explained part of the clinical outcome benefit of TGC.
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Further reduction of T3 is associated with improving patient mortality rates.
“Further statistical analysis showed that the further reduction of T3 was associated with improving patient mortality rates [92, 93].”
From An update on non-thyroidal illness syndrome (2021) · cites this paper as [93]
The Results (page not available) report that tight glucose control further reduced T3 and the T3/rT3 ratio, and that a lower ratio statistically explained part of the benefit in earlier live ICU discharge. The analysis did not show that a reduction in T3 alone was associated with a lower mortality rate; its measured outcome was time to live ICU discharge. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTargeting fasting blood glucose concentrations with intensive insulin treatment in children with critical illness to values mimicking a fasting response results in improved outcomes but aggravates peripheral NTIS.
“targeting of fasting blood glucose concentrations with intensive insulin treatment in children with critical illness to values mimicking a fasting response, resulted in improved outcomes, but at the same time aggravated peripheral NTIS.”
From An update on non-thyroidal illness syndrome (2021) · cites this paper as [93]
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- Authors
- Gielen, M., Mesotten, D., Wouters, P. J., Desmet, L., Vlasselaers, D., Vanhorebeek, I., Langouche, L., & Van den Berghe, G.
- Affiliations
- KU Leuven (BE)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-10
- Volume
- 97
- Issue
- 10
- Pages
- 3569-3576
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3462949
- OpenAlex
- W2050267038
- Cited by
- 22
- References
- 45
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 5 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 2 · 2013: 1
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- tight glycemic control, insulin therapy, hypothalamic-pituitary-thyroid axis, critically ill children, pediatric intensive care, thyroid-stimulating hormone, free triiodothyronine, reverse T3, thyroid hormone inactivation, intensive care unit discharge, fasting response
- MeSH terms
- Adolescent, Blood Glucose, Child, Child, Preschool, Critical Care, Fasting, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Infant, Infant, Newborn, Insulin, Male, Predictive Value of Tests, Risk Factors, Thyroid Gland, Thyroid Hormones, Proportional Hazards Models, Critical Illness
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