الفهرس 
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Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and ”septic shock” the subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality.
Hemodynamic disturbances occur in sepsis, such as cardiovascular and hormonal balance disorders. Hormonal changes that frequently occur in sepsis are often from the thyroid, in the form of Non-Thyroidal Illness Syndrome (NTIS).
NTIS is extensively studied in adults and ICUs but poorly studied in pediatrics and PICUs.
NTIS has been described in almost every form of acute or chronic stress and severe illness, infection, trauma, surgery, sepsis and heart disease.
As in adults, critical illness in children evokes pronounced changes in the thyroid axis. A low serum concentration of T3 and a rise in rT3 are typically observed in the acute phase of critical illness, possibly reflecting an attempt to reduce energy expenditure. Such peripheral inactivation of thyroid hormone is mainly explained by a decrease in type-1deiodinase activity in liver and kidney, and an increase in type-3 deiodinase activity in liver and muscle.
Thyroid dysfunction has also been found to be associated with the mortality of patients admitted to the PICU.
So, our study was done to assess the hormonal changes of NTIS in sepsis and septic shock patients and its frequency, also to examine the applicability of FT3, FT4, TSH and rT3 in determining their relation to prognosis of diseases in pediatric intensive care units and its relation to severity of diseases.
The study included 40 pediatric patients admitted in pediatric intensive care unit in Ain Shams University Hospital of both sexes. Age of them was from 6 months to 10 years.
Patients were categorized into two groups: Sepsis group and septic shock with 20 patients in each group.
All patients were subjected to the following:
1. Full medical history
Personal history (age and sex).
History of present illness.
Past history of medical importance.
Long of stay in PICU.
Duration of mechanical ventilation
2. Through clinical examination:
Anthropometric measurements: Weight (kg) and length or height (cm).
Vital data monitoring
Ventilatory support and its setting in mechanically ventilated patients.
3. Measurements
Routine lab investigations: CBC, CRP, Urea, Creatinine, SGPT, SGOT, Direct and Total bilirubin and Blood Culture.
Specific laboratory investigations: Assessment of thyroid hormone levels (FT3, FT4, TSH and rT3) for all cases by ELISA at day 1 and day 5 of illness.
4. Scoring system
Pediatrics sequential organ failure assessment (pSOFA) scores were calculated on studied patients in day1 and day 5 of illness
Results of our study showed:
About 45.5% of critically ill children showed hormone abnormalities consistent with NTIS.
NTIS was significant in septic shock groups compared to sepsis 65% versus 30%.
NTIS more prevalent among non survivors than survivors.
NTIS was negatively correlated with stay in PICU, ventilation and catecholamines infusion
By ROC curve, FT3 levels in day 5 was the best in predicting PICU mortality (sensitivity 100%, and specificity 68.42%), Followed by SOFA score day 5 (sensitivity 100%, and specificity 57.89%).
In the multivariate regression analysis, we discovered that high rT3 levels in day1 and CRP in day5 were independently associated with PICU mortality.