Thyroid hormone alterations in trauma patients requiring massive transfusion: An observational study

doi:10.5847/wjem.j.issn.1920-8642.2014.04.005

Abstract

Abstract:

BACKGROUND: Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported.
METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.
RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL; P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 µIU/mL) were higher than at admission (1.48±0.5 µIU/mL) in group C (P<0.05).
CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.

Key words: Non-thyroidal illness syndrome, Massive transfusion, Trauma, Free triiodothyronine, Thyroid hormone

Toru Hifumi, Ichiro Okada, Nobuaki Kiriu, Eiju Hasegawa, Tomoko Ogasawara, Hiroshi Kato, Yuichi Koido, Junichi Inoue, Yuko Abe, Kenya Kawakita, Masanobu Hagiike, Yasuhiro Kuroda. Thyroid hormone alterations in trauma patients requiring massive transfusion: An observational study[J]. World Journal of Emergency Medicine, 2014, 5(4): 270-274.

Figures/Tables 5

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Variables	Massive transfusion (n=19)	Controls (n=19)	P value
Age (yr)	44.4±23.2	57.2±24.5	0.12
Gender, male, n (%)	17 (89.4)	15 (78.9)	0.30
Mechanism of injury Penetrating/Blunt	2/17	0/19	0.16
Interval between injury and admission (min)	47.2±21.8	51.5±13.9	0.49
ISS	30.7±2.9	16.0±2.9	<0.01
Lactate (mmol/L)	3.0±1.7	2.6± 2.4	0.62
SBP (mmHg)	102.0±30.0	130.6±28.8	<0.01

Variables	Massive transfusion (n=19)	Controls (n=19)	P value
Transfusion required within 24 h: RCC (U)	19.3±8.8	0.8±2.1	<0.01
FFP (U)	18.7±9.5	1.1±2.9	<0.01
PC (U)	13.5±11.7	0	<0.01
Calcium administration (for the first seven days, mg)	4247±3038	141± 601	<0.01
Catecholamine administration, n (%)	0 (0)	0 (0)
Glucocorticoid administration, n (%)	3 (15.8)	2 (10.5)	0.65
Insulin administration, n (%)	0 (0)	0 (0)
Mortality within 28 days, n (%)	0 (0)	1 (5.3)	0.47
Mortality during hospitalization, n (%)	0 (0)	1 (5.3)	0.47

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