Effect of Tight Glucose Control with Insulin on the Thyroid Axis of Critically Ill Children and Its Relation with Outcome

Gielen, Marijke; Mesotten, Dieter; Wouters, Pieter; Desmet, Lars; Vlasselaers, Dirk; Vanhorebeek, Ilse; Langouche, Lies; Berghe, Greet Van den

doi:10.1210/jc.2012-2240

Cited by 22 publications

(31 citation statements)

References 45 publications

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“…Our study analyzed 3,933 pediatric patients and intended to expand the trial volume. Both in vitro and in vivo studies revealed that insulin therapy had positive effects of improving organ functions and alleviating inflammatory responses (30)(31)(32). Although tight glycemic control may bring clinical benefits in theory, the pooled analysis of present study did not show obvious survival benefits of TGC compared with CGC in critically ill children.…”

Section: Discussioncontrasting

confidence: 54%

Tight glycemic control in critically ill pediatric patients: a meta-analysis and systematic review of randomized controlled trials

Zhao

Xiang

2018

Pediatr Res

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BackgroundThere still are controversies in the impact of tight glycemic control (TGC) in critically ill children. The aim of this study was to assess the benefits and risks of TGC compared with conventional glycemic control (CGC) in critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) by using the data retrieved from randomized controlled trials (RCTs).MethodsEMBASE, CNKI, PubMed, and the Cochrane Database were searched for RCTs comparing TGC with CGC in critically ill children in PICU.ResultsThe meta-analysis included 5 RCTs representing 3,933 patients that compared TGC with CGC. Our result revealed that TGC did not reduce 30-day mortality rates (odds ratio (OR) 0.99, 95% confidence interval (CI) 0.74-1.32, P=0.95) and was not associated with decreasing health care-associated infections (OR 0.80, 95% CI 0.64-1.00, P=0.05) compared with CGC, but significantly increased the incidence of hypoglycemia (OR 6.37, 95% CI 4.41-9.21, P<0.001).ConclusionTight glycemic control was not associated with reducing 30-day mortality rates and acquired infections compared with CGC in critically ill children. Significant increase of incidence of hypoglycemia was revealed in TGC group. The conclusion should be interpreted with caution for the methodological heterogeneity among trials.

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Section: Discussioncontrasting

confidence: 54%

Tight glycemic control in critically ill pediatric patients: a meta-analysis and systematic review of randomized controlled trials

Zhao

Xiang

2018

Pediatr Res

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“…In such clinical studies, it is necessary to measure serum levels of rT3, as well as T4 and T3, to gain more information about the diseases. Even in recent studies measuring rT3 [ 16 , 17 ], measurements were made by RIA, which is the most reliable but very old technique [ 18 ]. However, the number of studies on rT3 has substantially decreased in recent years.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Serum Levels of 3,3ʹ,5ʹ-Triiodothyronine and Thyroid Hormones Measured by Liquid Chromatography-Tandem Mass Spectrometry and Immunoassay

et al. 2015

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ObjectiveFor measuring serum 3,3′,5′-triiodothyronine (rT3) levels, radioimmunoassay (RIA) has traditionally been used owing to the lack of other reliable methods; however, it has recently become difficult to perform. Meanwhile, liquid chromatography-tandem mass spectrometry (LC-MS/MS) has recently been attracting attention as a novel alternative method in clinical chemistry. To the best of our knowledge, there are no studies to date comparing results of the quantification of human serum rT3 between LC-MS/MS and RIA. We therefore examined the feasibility of LC-MS/MS as a novel alternative method for measuring serum rT3, thyroxine (T4), and 3,5,3′-triiodothyronine (T3) levels.MethodsAssay validation was performed by LC-MS/MS using quality control samples of rT3, T4, and T3 at 4 various concentrations which were prepared from reference compounds. Serum samples of 50 outpatients in our department were quantified both by LC-MS/MS and conventional immunoassay for rT3, T4, and T3. Correlation coefficients between the 2 measurement methods were statistically analyzed respectively.ResultsMatrix effects were not observed with our method. Intra-day and inter-day precisions were less than 10.8% and 9.6% for each analyte at each quality control level, respectively. Intra-day and inter-day accuracies were between 96.2% and 110%, and between 98.3% and 108.6%, respectively. The lower limit of quantification was 0.05 ng/mL. Strong correlations were observed between the 2 measurement methods (correlation coefficient, T4: 0.976, p < 0.001; T3: 0.912, p < 0.001; rT3: 0.928, p < 0.001).ConclusionsOur LC-MS/MS system requires no manual cleanup operation, and the process after application of a sample is fully automated; furthermore, it was found to be highly sensitive, and superior in both precision and accuracy. The correlation between the 2 methods over a wide range of concentrations was strong. LC-MS/MS is therefore expected to become a useful tool for clinical diagnosis and research.

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“…Use of a multivariate, Cox proportional hazard analysis showed that the further reduction of T 3 and rT 3 accounted for part of the therapy improving patient mortality rates. 82 …”

Section: Pathogenesis Of Ntismentioning

confidence: 99%

Thyroid function in critically ill patients

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Bianco

Langouche

et al. 2015

The Lancet Diabetes & Endocrinology

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318

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Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and macronutrient restriction, which might be beneficial. Pathogenesis of NTIS in long-term critical illness is more complex and includes suppression of hypothalamic thyrotropin-releasing hormone, accounting for persistently reduced secretion of thyroid-stimulating hormone despite low plasma thyroid hormone. In some cases distinguishing between NTIS and severe hypothyroidism, which is a rare primary cause for admission to the ICU, can be difficult. Infusion of hypothalamic-releasing factors can reactivate the thyroid axis in patients with NTIS, inducing an anabolic response. Whether this approach has a clinical benefit in terms of outcome is unknown. In this Series paper, we discuss diagnostic aspects, pathogenesis, and implications of NTIS as well as its distinction from severe, primary thyroid disorders in patients in the ICU.

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Effect of Tight Glucose Control with Insulin on the Thyroid Axis of Critically Ill Children and Its Relation with Outcome

Abstract: 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.

Cited by 22 publications

References 45 publications

Tight glycemic control in critically ill pediatric patients: a meta-analysis and systematic review of randomized controlled trials

Tight glycemic control in critically ill pediatric patients: a meta-analysis and systematic review of randomized controlled trials

Correlation between Serum Levels of 3,3ʹ,5ʹ-Triiodothyronine and Thyroid Hormones Measured by Liquid Chromatography-Tandem Mass Spectrometry and Immunoassay

Thyroid function in critically ill patients

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