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Войти в исследования Thyroid Storm in the ICU: A Retrospective Multicenter Study.
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Bourcier Simon, Coutrot Maxime, Kimmoun Antoine, Sonneville Romain, de Montmollin Etienne, Persichini Romain, Schnell David, Charpentier Julien, Aubron Cécile, Morawiec Elise, Bigé Naïke, Nseir Saad, Terzi Nicolas, Razazi Keyvan, Azoulay Elie, Ferré Alexis, Tandjaoui-Lambiotte Yacine, Ellrodt Olivier, Hraiech Sami, Delmas Clément, Barbier François, Lautrette Alexandre, Aissaoui Nadia, Repessé Xavier, Pichereau Claire, Zerbib Yoann, Lascarrou Jean-Baptiste, Carreira Serge, Reuter Danielle, Frérou Aurélien, Peigne Vincent, Fillatre Pierre, Megarbane Bruno, Voiriot Guillaume, Combes Alain, Schmidt Matthieu
Аннотация
DESIGN: Retrospective, multicenter, national study over an 18-year period (2000-2017).
SETTING: Thirty-one French ICUs.
PATIENTS: The local medical records of patients from each participating ICU were screened using the International Classification of Diseases, 10th Revision. Inclusion criteria were "definite thyroid storm," as defined by the Japanese Thyroid Association criteria, and at least one thyroid storm-related organ failure.
MEASUREMENTS AND MAIN RESULTS: Ninety-two patients were included in the study. Amiodarone-associated thyrotoxicosis and Graves' disease represented the main thyroid storm etiologies (30 [33%] and 24 [26%] patients, respectively), while hyperthyroidism was unknown in 29 patients (32%) before ICU admission. Amiodarone use (24 patients [26%]) and antithyroid-drug discontinuation (13 patients [14%]) were the main thyroid storm-triggering factors. No triggering factor was identified for 30 patients (33%). Thirty-five patients (38%) developed cardiogenic shock within the first 48 hours after ICU admission. In-ICU and 6-month postadmission mortality rates were 17% and 22%, respectively. ICU nonsurvivors more frequently required vasopressors, extracorporeal membrane of oxygenation, renal replacement therapy, mechanical ventilation, and/or therapeutic plasmapheresis. Multivariable analyses retained Sequential Organ Failure Assessment score without cardiovascular component (odds ratio, 1.22; 95% CI, 1.03-1.46; p = 0.025) and cardiogenic shock within 48 hours post-ICU admission (odds ratio, 9.43; 1.77-50.12; p = 0.008) as being independently associated with in-ICU mortality.
CONCLUSIONS: Thyroid storm requiring ICU admission causes high in-ICU mortality. Multiple organ failure and early cardiogenic shock seem to markedly impact the prognosis, suggesting a prompt identification and an aggressive management.