Báo cáo y học: Predictors of outcome in myxoedema coma: a study from a tertiary care centre

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Predictors of outcome in myxoedema coma: a study from a tertiary care centre...
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Báo cáo y học: "Predictors of outcome in myxoedema coma: a study from a tertiary care centre" Available online http://ccforum.com/content/12/1/R1Research Open AccessVol 12 No 1Predictors of outcome in myxoedema coma: a study from a tertiarycare centrePinaki Dutta1, Anil Bhansali1, Shriq Rashid Masoodi1, Sanjay Bhadada1, Navneet Sharma2 andRajesh Rajput11Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India2Department of Critical Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, IndiaCorresponding author: Anil Bhansali, anilbhansali_endocrine@rediffmail.comReceived: 17 Aug 2007 Revisions requested: 10 Sep 2007 Revisions received: 18 Oct 2007 Accepted: 3 Jan 2008 Published: 3 Jan 2008Critical Care 2008, 12:R1 (doi:10.1186/cc6211)This article is online at: http://ccforum.com/content/12/1/R1© 2008 Dutta et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractBackground With the easy availability of thyroid hormone presented early to the hospital and had more severeassays, thyroid disorders are now recognised even in a manifestations than de novo subjects. Nineteen (82%) hadsubclinical state. However, patients are still seen with advanced thyroprivic (primary) and 4 (17%) had trophoprivic (secondary)manifestations of the disease, particularly in developing hypothyroidism. Fifteen (65%) patients presented in the wintercountries. This observational study analysed the predictors of and in 17 (74%) sepsis was the major accompanyingoutcome in patients with myxoedema coma and tested the comorbidity. Twelve (52%) had a history of diuretic use, therebyvalidity of different modules to define morbidity and mortality in delaying the initial diagnosis. Patients who received oral L-these patients. thyroxine had no difference in outcome from those receiving IV thyroxine. Twelve (52%) subjects died and sepsis was theMethods Twenty-three consecutive patients with myxoedema predominant cause of death. Various predictors of mortalitycoma who presented from January 1999 to August 2006 were included hypotension (p = 0.01) and bradycardia (p = 0.03) atstudied. The thyroid function test and random serum cortisol presentation, need for mechanical ventilation (p = 0.00),were measured in all patients at the time of admission. Patients hypothermia unresponsive to treatment (p = 0.01), sepsis (p =were given oral or intravenous (IV) thyroxine with intention to 0.01), intake of sedative drugs (p = 0.02), lower GCS (p =treat with the latter according to availability. Various modules 0.03), high APACHE II score (p = 0.04), and high SOFA scorethat predict outcome, including Glasgow Coma Scale (GCS), (p = 0.00). However, SOFA score was more effective than otherAcute Physiology and Chronic Health Evaluation II (APACHE II) predictive models as baseline and day 3 SOFA scores of morescore, and Sequential Organ Failure Assessment (SOFA) score, than 6 were highly predictive of poor outcome.were analysed. SOFA score was repeated every 2 days until thetime of discharge or demise. Conclusion L-Thyroxine treatment defaulters had more severeResults Twenty-three patients (20 women; 87%) of 59.5 ± 14.4 manifestations compared with de novo subjects. Outcome wasyears of age (range, 30 to 89 years) were seen during the study not influenced by either aetiology or route of administration of L-period. Nine (39%) patients were diagnosed with thyroxine, and SOFA score was the best outcome predictorhypothyroidism for the first time at the time of presentation of model.myxoedema coma, whereas 14 (70%) were diagnosed withhypothyroidism previously. However, the treatment defaultersIntroduction ally occurs in elderly women and is precipitated by a second-Myxoedema coma is an uncommon and life-threatening form ary insult such as cold exposure, infection, drugs such asof long-standing, neglected, untreated hypothyroidism with sedative-hypnotics, lithium overdoses, and associated sys-physiological decompensation [1]. This endocrine crisis usu- temic diseases [1,2]. Clinically, it is characterised by lethargy,APACHE II = Acute Physiology and Chronic Health Evaluation II; ECG = electrocardiogram; GCS = Glasgow Coma Scale; IV = intravenous; SD =standard deviation; SOFA = Sequential Organ Failure Assessment; T3 = triiodothyronine; T4 = thyroxine; TSH = thyroid-stimulating hormone. Page 1 of 8 (page number not for citation purposes)Critical Care Vol 12 No 1 Dutta et al.myxoedematous manifestation, and altered s ...