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Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients' risks and to establish the adequate surgical indications., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Objective: To describe euthyroid sick syndrome (ESS) and its different clinical variants in severe acute illness., Design: This prospective cohort study examined hormone results and outcome for patients admitted to our intensive care unit (ICU)., Methods: In this heterogeneous group of 108 patients from our ICU we analyzed the prevalence of ESS and its influence on mortality and sought to determine if any thyroid indicators had a prognostic value., Results: The prevalence of ESS was similar to that described by other authors (68.5% for ESS type I, 15.7% for type II and 1.9% for type III). Patients developed thyroid alterations on their third day of hospitalization and those with ESS type II had a higher mortality rate. The only thyroid indicator with prognostic value was a reverse triiodothyronine (rT3) value exceeding 0.61 ng/mL., Conclusion: Severe acute illness induced the thyroid alterations known as ESS. Type I had the highest prevalence, but type II was correlated with a higher mortality rate. The only thyroid indicator with a prognostic value was rT3.