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

• Published in: PloS one Vol. 15; no. 12; p. e0243990
• Main Authors: Inghammar, Malin, Sunden-Cullberg, Jonas
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.12.2020; Public Library of Science (PLoS)
• 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; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0243990

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<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<0.001). Women had 0.2°C lower median BT-ED (p = 0.03) and 0.3°C lower BT-ICU (p<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.