Prevalencia y valor pronóstico del síndrome eutiroideo enfermo en niños críticamente enfermos
DOI:
https://doi.org/10.22529/me.2022.7(4)02Parole chiave:
síndrome eutiroideo enfermo, enfermedad crítica, valor pronóstico, pediatríaAbstract
INTRODUCCIÓN: el síndrome eutiroideo enfermo (SEE) es la principal anomalía endocrinológica en enfermos críticos. La presencia y gravedad del SEE se asocia a peor evolución clínica.OBJETIVO: conocer la prevalencia del SEE en niños críticamente enfermos y su correlación con la gravedad y resultado clínico de la enfermedad.MATERIAL Y MÉTODO: estudio prospectivo, observacional y analítico en niños críticamente enfermos internados en terapia intensiva entre mayo de 2019 y mayo de 2020. Se definió al SEE como la alteración tiroidea en enfermos críticos sin patología hipotálamo-hipófiso-tiroidea preexistente. Las variables analizadas fueron: edad, sexo, duración de internación, decesos, requerimiento de ventilación mecánica e inotrópicos, diagnóstico al ingreso, PIM3. Para variables cualitativas se utilizó test de Chi cuadrado, para variables cuantitativas, test de Wilcoxon.RESULTADOS: de 47 pacientes estudiados, 28 (60%) presentaron SEE. No hubo diferencias respecto a sexo (p>0,999), decesos (p>0,999) ni uso de inotrópicos (p=0,1564). Hubo asociación significativa entre SEE y más días de internación (p= 0.0390) y mayor requerimiento de ventilación mecánica invasiva (p= 0.0261) y entre valores bajos de hormonas tiroideas y mayor coeficiente y probabilidad de mortalidad del PIM3 (p<0,0001 y p<0,001, respectivamente).CONCLUSIONES: el SEE es frecuente en niños críticos y se asocia a dos indicadores de gravedad: duración de internación y requerimiento de ventilación mecánica invasiva. La asociación entre valores bajosde hormonas tiroideas y altos coeficientes y probabilidad de mortalidad permite usar el análisis tiroideo para predecir la evolución clínica de niños críticamente enfermos.Downloads
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