Prognostic significance of body temperature in the emergency department vs the ICU in Patients with severe sepsis or septic shock: A nationwide cohort study

Increased body temperature in the Emergency Department (BT-ED) and the ICU (BT-ICU) is associated with lower mortality in patients with sepsis. Here, we compared how well BT-ED and BT-ICU predict mortality; investigated mortality in various combinations of BT-ED and BT-ICU, and; compared degree of f...

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Published in:PloS one 2020-12, Vol.15 (12), p.e0243990-e0243990
Main Authors: Inghammar, Malin, Sunden-Cullberg, Jonas
Format: Article
Language:English
Subjects:
Age Factors
Aged
Anestesi och intensivvård
Anesthesiology and Intensive Care
Antibiotics
Biology and Life Sciences
Body Temperature
Clinical Medicine
Cohort analysis
Comparative analysis
Critical Care - methods
Data collection
Emergency medical care
Emergency medical services
Emergency service
Emergency Service, Hospital - statistics & numerical data
Female
Fever
Health aspects
Hospitals
Humans
Infectious diseases
Influence
Intensive care
Intensive care units
Intensive Care Units - statistics & numerical data
Klinisk medicin
Male
Medical and Health Sciences
Medical prognosis
Medicin och hälsovetenskap
Medicine and Health Sciences
Men
Middle Aged
Mortality
Mortality - trends
Patients
Predictive Value of Tests
Prognosis
Sepsis
Septic shock
Sex Factors
Shock, Septic - epidemiology
Shock, Septic - mortality
Shock, Septic - pathology
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Sunden-Cullberg, Jonas
description Increased body temperature in the Emergency Department (BT-ED) and the ICU (BT-ICU) is associated with lower mortality in patients with sepsis. Here, we compared how well BT-ED and BT-ICU predict mortality; investigated mortality in various combinations of BT-ED and BT-ICU, and; compared degree of fever in the ED and ICU and associated quality of care. 2385 adults who were admitted to an ICU within 24 hours of ED arrival with severe sepsis or septic shock were included. Thirty-day mortality was 23.6%. Median BT-ED and BT-ICU was 38.1 and 37.6°C. Crude mortality decreased more than 5% points per°C increase for both BT-ED and BT-ICU. Adjusted OR for mortality was 0.82/°C increase for BT-ED (0.76-0.88, p < 0.001), and 0.89 for BT-ICU (0.83-0.95, p
doi_str_mv 10.1371/journal.pone.0243990
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Here, we compared how well BT-ED and BT-ICU predict mortality; investigated mortality in various combinations of BT-ED and BT-ICU, and; compared degree of fever in the ED and ICU and associated quality of care. 2385 adults who were admitted to an ICU within 24 hours of ED arrival with severe sepsis or septic shock were included. Thirty-day mortality was 23.6%. Median BT-ED and BT-ICU was 38.1 and 37.6°C. Crude mortality decreased more than 5% points per°C increase for both BT-ED and BT-ICU. Adjusted OR for mortality was 0.82/°C increase for BT-ED (0.76-0.88, p &lt; 0.001), and 0.89 for BT-ICU (0.83-0.95, p&lt;0.001). Patients who were at/below median temperature in both the ED and in the ICU had the highest mortality, 32%, and those with over median in the ED and at/below in the ICU had the lowest, 16%, (p&lt;0.001). Women had 0.2°C lower median BT-ED (p = 0.03) and 0.3°C lower BT-ICU (p&lt;0.0001) than men. Older patients had lower BT in the ICU, but not in the ED. Fever was associated with a higher rate of sepsis bundle achievement in the ED, but lower nurse workload in the ICU. BT-ED was more useful to prognosticate mortality than BT-ICU. Despite better prognosis in patients with elevated BT, fever was associated with higher quality of care in the ED. Future studies should assess how BT-ED can be used to improve triage of infected patients, assigning higher priority to patients with low-grade/no fever and vice versa. Patients with at/below median BT in both ED and ICU have the highest mortality and should receive special attention. Different BT according to sex and age also needs further study.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33373376</pmid><doi>10.1371/journal.pone.0243990</doi><tpages>e0243990</tpages><orcidid>https://orcid.org/0000-0002-8189-4960</orcidid><oa>free_for_read</oa></addata></record>
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1932-6203
language eng
recordid cdi_plos_journals_2473727710
source Publicly Available Content Database; PubMed Central
subjects Age Factors
Aged
Anestesi och intensivvård
Anesthesiology and Intensive Care
Antibiotics
Biology and Life Sciences
Body Temperature
Clinical Medicine
Cohort analysis
Comparative analysis
Critical Care - methods
Data collection
Emergency medical care
Emergency medical services
Emergency service
Emergency Service, Hospital - statistics & numerical data
Female
Fever
Health aspects
Hospitals
Humans
Infectious diseases
Influence
Intensive care
Intensive care units
Intensive Care Units - statistics & numerical data
Klinisk medicin
Male
Medical and Health Sciences
Medical prognosis
Medicin och hälsovetenskap
Medicine and Health Sciences
Men
Middle Aged
Mortality
Mortality - trends
Patients
Predictive Value of Tests
Prognosis
Sepsis
Septic shock
Sex Factors
Shock, Septic - epidemiology
Shock, Septic - mortality
Shock, Septic - pathology
title Prognostic significance of body temperature in the emergency department vs the ICU in Patients with severe sepsis or septic shock: A nationwide cohort study
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