Non-Thyroidal Illness Syndrome: A Predictor of Non-Invasive Ventilation Failure and Mortality in Critically Ill Patients.

Aim: This study aimed to investigate the effect of Euthyroid Sick Syndrome (ESS) on non-invasive mechanical ventilation (NIV) failure and in-hospital mortality. We also examined the impact of prolonged low fT3 levels before intensive care unit (ICU) admission on mortality and NIV failure.

Methods

The study included 386 ICU patients who received NIV. The patients were categorized into two groups: those with ESS and those without (Non-ESS). Additionally, retrospective fT3 levels were examined in the ESS group over 6 months before ICU admission, and 61 patients with prolonged ESS were identified. The primary endpoints of this study (NIV failure and mortality) were compared between study groups.

Results

Of the 386 patients included in the study, comprising 332 survivors and 54 deceased individuals, ESS was observed in 49.0% of the total patient population, with a significantly higher prevalence (p = 0.005) among deceased patients (66.7%) compared to survivors (46.1%). Among the 189 patients with low fT3 levels, there was a significant disparity between survivors and deceased patients (p < 0.001). Of these, 32.3% had low fT3 levels both before and during ICU admission (prolonged ESS), with 26.1% survivors and 58.3% deceased (p < 0.001). NIV failure was significantly more common in the ESS group (44.4%) than in the non-ESS group (26.4%; p < 0.001).

Conclusion

Our study demonstrates that ESS, mainly characterized by low fT3 levels, was significantly associated with increased mortality rates in ICU patients and a higher failure rate of NIV.