PERSPECTIVES OF STUDY OF TIEROID PROFILE IN PATIENTS WITH ORGAN DYSFUNCTIONS IN ACUTE PANCREATITIS

Kasian V. V., Cherkun O. Yu., Sytnik D. A., Sheiko V. D.

LITERATURE REVIEWS

Scentific article

Existing evaluation systems for predicting mortality in patients with acute pancreatitis have limited accuracy and limited clinical significance. True markers that would allow for several indicators to diagnose organ dysfunction in acute pancreatitis in the early phase and to predict its course has not yet been found, which leads to the search for such laboratory indicators to solve the problem of early diagnosis and treatment. Low T3 syndrome is a predictor of the progression of progressive multiple organ failure and unfavorable course of somatic pathology. Goal. The purpose of the work was to analyze the publications of recent years on the possibility of using ball systems and individual markers, such as thyroxine and triiodothyronine, in predicting the adverse course of acute pancreatitis. Research methods. The search and analysis of the literature of the base “Medline” was carried out for the key words: acute pancreatitis, pancreatic ascites, prediction of gravity, low T3 syndrome, low T4 syndrome. The depth of search is publications in peer-reviewed journals included in international science-computer databases over the past 5 years. Main part. The multifactorial specific and universal scales used in patients with GPs are cumbersome and require up to 48 hours to evaluate all the indicators, a large number of clinical laboratory and instrumental tests, and are little adapted to the domestic health system. Forecasting continues to be a valuable tool in the clinic, but in order to increase clinical benefit, it should provide for realistic factors of severity – (peri) pancreatic necrosis and/or organ failure. The identification of early markers of persistent organ failure is important because there are concerns, especially among intensive caregivers, that patients are often hospitalized in an intensive care unit too late. In our opinion, the evaluation of the thyroid profile can help predict persistent organ failure in patients with acute pancreatitis. The magnitude of changes in the function of the thyroid gland in patients with non-thyroid disease varies depending on the severity of the disease. The results obtained indicate that pancreatitis can play a role in the emergence of these changes. In subsequent studies, these changes in thyroid function may correlate with the prognosis for acute pancreatitis. Conclusions. The high death rate from acute pancreatitis is due to multiple organ failure and the development of infectious-septic complications, and the appearance of thyroid dysfunction in the background of diagnosed prolonged or transient organ failure indicates a very poor prognosis for the patient. Correction of surgical tactics in the direction of maximum radical rehabilitation effect is likely to improve the results of treatment in this category of patients. Taking into account the above, determining the thyroid hormones in patients with acute severe pancreatitis will help to identify patients who are expected to have a more severe course of the disease, and correction of surgical tactics in this group of patients will help improve the results of treatment. Further prospective studies are needed to support this hypothesis.

pancreatitis, prognosis of severity, low T3 syndrome, low T4 syndrome, multiple organ failure

1. Hackethal V. Pancreatitis Mortality Prediction Models Lack Evidence. 2016. Available from: https://www.medscape.com/viewarticle/866769
2. Slag MF, Morley JE, Elson MK, Crowson TW, Nuttall FQ, Shafer RB. Hypothyroxinemia as a Critically III Patients Predictor of High Mortality. Jama. 1981;245:43-5.
3. Pingitore A, Landi P, Taddei MC, Ripoli A, L’Abbate A, Iervasi G. Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med. 2005;118(2):132-6.
4. Cherkun OYu, Kasian VV, Kaliuzhka AS, Sheiko VD. Prohnozuvannia etapnykh khirurhichnykh vtruchan pry infektsiino-septychnykh uskladnenniakh destruktyvnoho pankreatytu. Aktualni problemy suchasnoi medytsyny: Visnyk Ukrainskoi medychnoi stomatolohichnoi akademii. 2017;17(3):315-8. [in Ukrainian].
5. Tang JCF. Acute Pancreatitis. 2017. Available from: https://emedicine.medscape.com/article/181364-overview
6. Papachristou GI, Muddana V, Yadav D, Sanders MK, Slivka A, Whitcomb DC. Comparison of BISAP, Ranson' APACHE-II, and CTSI Scores in Predicting Organ Failure, Complications, and Mortality in Acute Pancreatitis. Am J Gastroenterol. 2009;105(2):435-41.
7. Gao W, Yang H-X, Ma C-E. The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and MetaAnalysis. PLoS One [Internet]. 2015;10(6):e0130412. Available from: http://dx.plos.org/10.1371/journal.pone.0130412
8. Valverde-López F, Matas-Cobos AM, Alegría-Motte C, Jiménez-Rosales R, Úbeda-Muñoz M, Redondo-Cerezo E. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol [Internet]. 2017. Available from: http://doi.wiley.com/10.1111/jgh.13763
9. Chandra S, Murali A, Bansal R, Agarwal D, Holm A. The Bedside Index for Severity in Acute Pancreatitis: a systematic review of prospective studies to determine predictive performance. J Community Hosp Intern Med Perspect [Internet]. 2017;7(4):208-13. Available from: https:// www.tandfonline.com/doi/full/10.1080/20009666.2017.1361292
10. Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008;57:1698-703.
11. Lowenfels AB, Maisonneuve P, Sullivan T. The Changing Character of Acute Pancreatitis: Epidemiology, Etiology, and Prognosis. Curr Gastroenterol Rep. 2009;11:97-103.
12. Di M-Y, Liu H, Yang Z-Y, Bonis PAL, Tang J-L, Lau J. Prediction Models of Mortality in Acute Pancreatitis in Adults. Ann Intern Med [Internet]. 2016;165(7):482. Available from: http://annals.org/article.aspx?doi=10.7326/M16-0650
13. Bradley Iii EL, Dexter ND. Management of Severe Acute Pancreatitis A Surgical Odyssey. Ann Surg. 2010;251:6-17.
14. Guo Q, Li A, Xia Q, Liu X, Tian B, Mai G, et al. The Role of Organ Failure and Infection in Necrotizing Pancreatitis A Prospective Study. Ann Surg. 2014;259:1201-7.
15. Rau BM, Kemppainen EA, Gumbs AA, Buchler MW, Wegscheider K, Bassi C, et al. Early Assessment of Pancreatic Infections and Overall Prognosis in Severe Acute Pancreatitis by Procalcitonin (PCT). Ann Surg [Internet]. 2007;245(5):745-54. Available from: http://content.wkhealth. com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-200705000-00012
16. Mofidi R, Suttie SA, Patil PV, Ogston S, Parks RW. The value of procalcitonin at predicting the severity of acute pancreatitis and development of infected pancreatic necrosis: systematic review. Surgery [Internet]. 2009;146(1):72-81. Available from: http://dx.doi.org/10.1016/j. surg.2009.02.013
17. Purkayastha S, Chow A, Athanasiou T, Cambaroudis A, Panesar S, Kinross J, et al. Does serum procalcitonin have a role in evaluating the severity of acute pancreatitis? A question revisited. World J Surg. 2006;30(9):1713-21.
18. Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013.
19. Li N, Wang B-M, Cai S, Liu P-L, Wen Y-H. The Role of serum high mobility group box 1 and interleukin-6 levels in acute pancreatitis: a metaanalysis Running title: HMGB1 and IL-6 with acute pancreatitis. J. Cell. Biochem. 2018;119:616-24. DOI: 10.1002/jcb.26222
20. Forsmark CE, Yadav D. Predicting the Prognosis of Acute Pancreatitis. Ann Intern Med. 2016;165(7):523.
21. Petrov MS. Predicting the severity of acute pancreatitis: choose the right horse before hitching the cart. Dig Dis Sci. 2011;56(12):3402-4.
22. Dellinger EP, Forsmark CE, Layer P, Lévy P, Maraví-Poma E, Petrov MS, et al. Determinant-Based Classification of Acute Pancreatitis Severity. Ann Surg [Internet]. 2012;256(6):875-80. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage& an=00000658-201212000-00001
23. Chopra IJ. Euthyroid sick syndrome: Is it a misnomer? J Clin Endocrinol Metab. 1997;82(2):329-34.
24. Robert D. Utiger. Altered thyroid function in nonthyroidal illness and surgery. To treat or not to treat? N Engl J Med. 1995;333:1562.
25. Davidson MB, Chopra IJ. Effect of carbohydrate and noncarbohydrate sources of calories on plasma 3, 5, 3’-triiodothyronine concentrations in man. J Clin Endocrinol Metab. 1979;48(4):577-81.
26. Peeters RP, Wouters PJ, Kaptein E, Van Toor H, Visser TJ, Van Den Berghe G. Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients. J Clin Endocrinol Metab. 2003;88(7):3202-11.
27. Peeters RP, Wouters PJ, Van Toor H, Kaptein E, Visser TJ, Van Den Berghe G. Serum 3,3’,5’-triiodothyronine (rT3) and 3,5,3’-triiodothyronine/ rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. J Clin Endocrinol Metab. 2005;90(8):4559-65.
28. Peeters RP, Kester MHA, Wouters PJ, Kaptein E, Van Toor H, Visser TJ, et al. Increased thyroxine sulfate levels in critically ill patients as a result of a decreased hepatic type I deiodinase activity. J Clin Endocrinol Metab. 2005;90(12):6460-5.
29. Arem R, Wiener GJ, Kaplan SG, Kim HS, Reichlin S, Kaplan MM. Reduced tissue thyroid hormone levels in fatal illness. Metabolism. 1993;42(9):1102-8.
30. Jirasakuldech B, Schussler GC, Yap MG, Drew H, Josephson A, Michl J. A characteristic serpin cleavage product of thyroxine-binding globulin appears in sepsis sera. J Clin Endocrinol Metab. 2000;85(11):3996-9.
31. Chopra IJ, Solomon DH, Hepner GW, Morgenstein AA. Misleadingly low free thyroxine index and usefulness of reverse triiodothyronine measurement in nonthyroidal illnesses. Ann Intern Med. 1979;90(6):905-12.
32. Wong TK, Pekary AE, Guy Soo Hoo, Bradley ME, Hershman JM. Comparison of methods for measuring free thyroxin in nonthyroidal illness. Clin Chem. 1992;38(5):720-4.
33. Chopra IJ, Teco GNC, Mead JF, Huang T-S, Beredo A, Solomon DH. Relationship between Serum Free Fatty Acids and Thyroid Hormone Binding Inhibitor in Nonthyroid Illnesses*. J Clin Endocrinol Metab [Internet]. 1985;60(5):980-4. Available from: https://academic.oup.com/jcem/ article-lookup/doi/10.1210/jcem-60-5-980
34. Lim CF, Bernard BF, Jong M De, Docter R, Krenning EP, Hennemann G. A furan fatty acid and indoxyl sulfate are the putative inhibitors of thyroxine hepatocyte transport in uremia. J Clin Endocrinol Metab. 1993;76(2):318-24.
35. Michael P. Casaer. Early versus Late Parenteral Nutrition in Critically Ill Adults. N Engl J Med. 2011;365:506-17.
36. Langouche L, Perre S Vander, Marques M, Boelen A, Wouters PJ, Casaer MP, et al. Impact of early nutrient restriction during critical illness on the nonthyroidal illness syndrome and its relation with outcome: a randomized, controlled clinical study. J Clin Endocrinol Metab. 2013;98(3):1006-13.
37. De Sola C, Redondo M, Pallares F, Redondo E, Hortas ML, Morell M. Thyroid function in acute pancreatitis. Rev Esp Enfermedades Dig. 1998;90(1):19-22. 

«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 43-47 pages, index UDK 616.37-002-06:616/618-008.64:612.44.018:616-07

10.29254/2077-4214-2019-1-1-148-43-47