Steffen Hering

Publications of Steffen Hering

• The AQUA-FONTIS Study: Protocol of a multidisciplinary, cross-sectional and prospective longitudinal study for developing standardized diagnostics and classification of non-thyroidal illness syndrome.

  Authors: Johannes Dietrich, Axel Stachon, Biljana Antic, Harald Klein, Steffen Hering

  BMC endocrine disorders. 11/2008; 8(1):13.

  ABSTRACT: BACKGROUND: Non-thyroidal illness syndrome (NTIS) is a characteristic functional constellation of thyrotropic feedback control that frequently occurs in critically ill patients. AlthoughABSTRACT: BACKGROUND: Non-thyroidal illness syndrome (NTIS) is a characteristic functional constellation of thyrotropic feedback control that frequently occurs in critically ill patients. Although this condition is associated with significantly increased morbidity and mortality, there is still controversy on whether NTIS is caused by artefacts, is a form of beneficial adaptation, or is a disorder requiring treatment. Trials investigating substitution therapy of NTIS revealed contradictory results. The comparison of heterogeneous patient cohorts may be the cause for those inconsistencies. Objectives: Primary objective of this study is the identification and differentiation of different functional states of thyrotropic feedback control in order to define relevant evaluation criteria for the prognosis of affected patients. Furthermore, we intend to assess the significance of an innovative physiological index approach (SPINA) in differential diagnosis between NTIS and latent (so-called "sub-clinical") thyrotoxicosis. Secondary objective is observation of variables that quantify distinct components of NTIS in the context of independent predictors of evolution, survival or pathophysiological condition and influencing or disturbing factors like medication. DESIGN: The approach to a quantitative follow-up of non-thyroidal illness syndrome (AQUA FONTIS study) is designed as both a cross-sectional and prospective longitudinal observation trial in critically ill patients. Patients are observed in at least two evaluation points with consecutive assessments of thyroid status, physiological and clinical data in additional weekly observations up to discharge. A second part of the study investigates the neuropsychological impact of NTIS and medium-term outcomes. The study design incorporates a two-module structure that covers a reduced protocol in form of an observation trial before patients give informed consent. Additional investigations are performed if and after patients agree in participation. Trial Registration: ClinicalTrials.gov NCT00591032.

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• Iodothyronine antibodies are not correlated with prevalence or prognosis of non-thyroidal illness syndrome

  Authors: Johannes W Dietrich, Antje Ackermann, Abira Jeyabalan, Yarlini Kunanayagam, Tabotnini Tharmalingam, Aline Urban, Axel Stachon, Harald H Klein, Steffen Hering

  European Congress of Endocrinology 2008, Berlin, Germany; 05/2008

  Patients suffering from critical illness usually exhibit a characteristic functional state of thyrotropic feedback control that is referred to as non-thyroidal illness syndrome (NTIS). Today, therePatients suffering from critical illness usually exhibit a characteristic functional state of thyrotropic feedback control that is referred to as non-thyroidal illness syndrome (NTIS). Today, there are still important questions unsolved, e.g. regarding the interdependence of immunological and endocrine functions in critical illness. Therefore, in the context of the prospective AQUA FONTIS study we investigated 164 patients that were treated in medical, surgical and heart surgical intensive care units (ICUs) of the Bergmannsheil university hospitals in Bochum, Germany. Here, we examined the titres of antibodies reacting with thyroxine (T4-ab) and triiodothyronine (T3-ab) that were determined 24 h after admission to the ICU, and investigated their correlation with parameters of thyroid homeostasis, length of stay in hospital (LOSIH) or ICU (LOSICU) and survival of patients. All patients exhibited Gaussian distributed antibody titres that were in the normal range for healthy volunteers. Moreover, the titres didn’t correlate with functional characteristics like thyrotroph thyroid hormone sensitivity index (TTSI) as a parameter for the central component of NTIS, or sum activity of 5′-deiodinase as a marker for impaired deiodination. Again, antibody titres didn’t exhibit correlation with survival, LOSIH or LOSICU, in the latter two cases even if only the subgroup of surviving patients was considered. In conclusion, despite of immunological activation, e.g. in case of sepsis, antibodies directed against T3 or T4 are not elevated among critically ill patients nor do they play a role in the prognosis of the disease. Endocrine Abstracts (2008) 16 P821

• A laboratory-based risk score for medical intensive care patients.

  Authors: Axel Stachon, Elmar Segbers, Steffen Hering, Reiner Kempf, Tim Holland-Letz, Michael Krieg

  Clinical chemistry and laboratory medicine : CCLM / FESCC. 01/2008; 46(6):855-62.

  Abstract Background: Established general risk score models for intensive care patients incorporate several clinical and laboratory data. However, the collection, documentation and classification ofAbstract Background: Established general risk score models for intensive care patients incorporate several clinical and laboratory data. However, the collection, documentation and classification of clinical data are time-consuming, incur labor-related costs, and are dependent on the experience of the examiner. Therefore, in the present study a general score for medical intensive care patients based solely on routine laboratory parameters is presented. Methods: Parameter selection was performed using stepwise logistic regression analysis. The maximum likelihood estimate of variable influence on mortality provided a relative weighting for each variable. The new score was compared to two established risk models (Acute Physiology And Chronic Health Evaluation II, APACHE II; and Simplified Acute Physiology Score II, SAPS II). Results: The study included 528 medical intensive care patients with a mean age of 65.4+/-0.7 years. The in-hospital mortality was 16.5% (87/528). Multiple logistic regression analysis revealed eight parameters with significant prognostic power: alanine aminotransferase, cholesterol, creatinine, leukocytes, sodium, thrombocytes, urea, and age. These parameters were used to build a new laboratory score called Critical Risk Evaluation by Early Keys (CREEK). The area under the receiver operating characteristics curve was 0.857 (0.814-0.900). Pearson correlation analysis showed significant correlation between CREEK and APACHE II (r=0.550) and SAPS II (r=0.516; p<0.001; n=387). The areas under curve of the APACHE II and the SAPS II were 0.869 and 0.874, respectively. Conclusions: We show that a general risk score for medical intensive care patients on admission based solely on routine laboratory parameters is feasible. The quality of risk estimation using CREEK is comparable to established risk models. Furthermore, this new score is based on quality controlled low-cost laboratory parameters that are routinely measured on admission to the intensive care unit. Therefore, no additional costs are involved. Clin Chem Lab Med 2008;46:855-62.

• Nucleated red blood cells in the blood of medical intensive care patients indicate increased mortality risk: a prospective cohort study.

  Authors: Axel Stachon, Elmar Segbers, Tim Holland-Letz, Reiner Kempf, Steffen Hering, Michael Krieg

  Critical care (London, England). 01/2007; 11(3):R62.

  INTRODUCTION: In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in theINTRODUCTION: In critically ill patients, the appearance of nucleated red blood cells (NRBCs) in blood is associated with a variety of severe diseases. Generally, when NRBCs are detected in the patients' blood, the prognosis is poor. METHODS: In a prospective study, the detection of NRBCs was used for a daily monitoring of 383 medical intensive care patients. RESULTS: The incidence of NRBCs in medical intensive care patients was 17.5% (67/383). The mortality of NRBC-positive patients was 50.7% (34/67); this was significantly higher (p < 0.001) than the mortality of NRBC-negative patients (9.8%, 31/316). Mortality increased with increasing NRBC concentration. Seventy-eight point six percent of the patients with NRBCs of more than 200/microl died. The detection of NRBCs is highly predictive of death, the odds ratio after adjustment for other laboratory and clinical prognostic indicators being 1.987 (p < 0.01) for each increase in the NRBC category (0/microl, 1 to 100/microl, 101 to 200/microl, and more than 200/microl). Each step-up in the NRBC category increased the mortality risk as much as an increase in APACHE II (Acute Physiology and Chronic Health Evaluation II) score of approximately 4 points. The mortality of patients who were NRBC-positive on the day of relocation from the intensive care unit to a peripheral ward was 27.6% (8/27). This was significantly higher than the mortality of patients who were NRBC-negative on the relocation day (8.6%, 28/325; p < 0.01). On average, NRBCs were detected for the first time 14 days (median, 3 days) before death. CONCLUSION: The routine analysis of NRBCs in blood is of high prognostic power with regard to mortality of critically ill patients. Therefore, this parameter may serve as a daily indicator of patients at high mortality risk. Furthermore, NRBC-positive intensive care patients should not be relocated to a normal ward but should obtain ongoing intensive care treatment.