ISSN: 1308-5727 | E-ISSN: 1308-5735
Volume : 16 Issue : 2 Year : 2024

Abstracting & Indexing
Turkish Society for Pediatric Endocrinology and Diabetes
Non-thyroidal Illness in Children with Congestive Heart Failure [J Clin Res Pediatr Endocrinol]
J Clin Res Pediatr Endocrinol. 2024; 16(2): 192-199 | DOI: 10.4274/jcrpe.galenos.2024.2023-12-7

Non-thyroidal Illness in Children with Congestive Heart Failure

Biswajit Sahoo1, Aashima Dabas1, Binita Goswami2, Anurag Agarwal1, Sumod Kurian3
1Maulana Azad Medical College and Lok Nayak Hospital, Clinic of Pediatrics, New Delhi, India
2Maulana Azad Medical College and Lok Nayak Hospital, Clinic of Biochemistry, New Delhi, India
3Govind Ballabh Pant Institute of Post-graduate Medical Training and Research, Clinic of Cardiology, New Delhi, India

INTRODUCTION: To estimate the proportion and risk factors of non-thyroidal illness (NTI) in children with congenital heart disease (CHD) with congestive heart failure (CHF).
METHODS: This study enrolled children (6 weeks to 60 months age) with CHD and CHF. The clinical profile and disease severity, derived from the Pediatric Early Warning Score (PEWS) was recorded. Baseline blood samples were taken within 24 hours of hospitalization and evaluated for free tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), N-terminal pro-brain natriuretic peptide (NT pro-BNP) and reverse T3.
RESULTS: A total of 80 (64 acyanotic CHD) children of median (interquartile range) age 5 (2.5, 8.0) months were enrolled. NTI was seen in 37 (46%) of whom 27 had low fT3 levels. The proportion of NTI was highest in children with severe disease (20/30), than moderate (4/9) or mild disease (13/41) (p=0.018). Ten (27%) patients with NTI died compared to 2 (4.7%) without NTI with unadjusted odds ratio (OR) [95% confidence interval (CI)] 7.593 (1.54, 37.38); p=0.006. After adjusting for NTI, shock and NT-pro-BNP levels, PEWS was the only significant predictor of mortality (OR: 1.41, 95% CI: 1.03, 1.92; p=0.032). Linear regression for fT3 identified a significant relationship with log NT-BNP [beta -3.541, (95% CI: -1.387, -0.388)] and with TSH [beta 2.652 (95% CI: 0.054, 0.383)]. The cutoff (area under the curve, 95% CI) that predicted mortality were fT4 <14.5 pmol/L (0.737, 0.60, 0.88), fT3/rT3 index <1.86 pg/ng (0.284, 0.129, 0.438) and NT pro-BNP >3725 pg/mL (0.702; 0.53, 0.88).
DISCUSSION AND CONCLUSION: NTI was present in a significant proportion of children with CHD and CHF. fT3 level was significantly associated with NTBNP levels and thus severity of CHF.

Keywords: Non-thyroidal illness, free T3, reverse T3, NT pro-BNP, Pediatric Early Warning Score

Biswajit Sahoo, Aashima Dabas, Binita Goswami, Anurag Agarwal, Sumod Kurian. Non-thyroidal Illness in Children with Congestive Heart Failure. J Clin Res Pediatr Endocrinol. 2024; 16(2): 192-199

Corresponding Author: Aashima Dabas, India
Manuscript Language: English
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