Significance of body temperature in elderly patients with sepsis

Critical Care

Naoshi Takeyama¹  Norio Yamashita²  Ryosuke Tsuruta³  Akiyoshi Hagiwara⁴  Seitaro Fujishima⁵  Keith R. Walley⁶  Yasukazu Shiino⁷  Toshihiko Mayumi⁸  Hiroto Ikeda⁹  Shin-ichiro Shiraishi^1,10  Takashi Shimazui^1,11  Taku Oshima^1,11  Taka-aki Nakada^1,11  Junichi Sasaki^1,12  Tomohiko Masuno^1,13  Toru Hifumi^1,14  Toshikazu Abe^1,15  Kohji Okamoto^1,16  Takehiko Tarui^1,17  Masashi Ueyama^1,18  Hiroshi Ogura^1,19  Yutaka Umemura^1,19  Satoshi Gando^2,20  Joji Kotani^2,21  Shigeki Kushimoto^2,22  Satoshi Fujimi^2,23  Kazuma Yamakawa^2,23  Daizoh Saitoh^2,24  Kiyotsugu Takuma^2,25  Yuichiro Sakamoto^2,26  Atsushi Shiraishi^2,27  Yasuhiro Otomo^2,28 

[1] Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan;Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan;Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan;Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan;Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan;Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada;Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan;Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan;Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan;Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan;Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, 260-8677, Chuo, Chiba, Japan;Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan;Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan;Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan;Department of General Medicine, Juntendo University, Tokyo, Japan;Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan;Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan;Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Japan;Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan;Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan;Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan;Acute and Critical Care Center, Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan;Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan;Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan;Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan;Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan;Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan;Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan;Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Japan;Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan;

关键词: Septic shock;    Elderly;    Body temperature;    Fever;    Hypothermia;   

DOI  :  10.1186/s13054-020-02976-6

来源: Springer

【 摘 要 】

BackgroundElderly patients have a blunted host response, which may influence vital signs and clinical outcomes of sepsis. This study was aimed to investigate whether the associations between the vital signs and mortality are different in elderly and non-elderly patients with sepsis.MethodsThis was a retrospective observational study. A Japanese multicenter sepsis cohort (FORECAST, n = 1148) was used for the discovery analyses. Significant discovery results were tested for replication using two validation cohorts of sepsis (JAAMSR, Japan, n = 624; SPH, Canada, n = 1004). Patients were categorized into elderly and non-elderly groups (age ≥ 75 or < 75 years). We tested for association between vital signs (body temperature [BT], heart rate, mean arterial pressure, systolic blood pressure, and respiratory rate) and 90-day in-hospital mortality (primary outcome).ResultsIn the discovery cohort, non-elderly patients with BT < 36.0 °C had significantly increased 90-day mortality (P = 0.025, adjusted hazard ratio 1.70, 95% CI 1.07–2.71). In the validation cohorts, non-elderly patients with BT < 36.0 °C had significantly increased mortality (JAAMSR, P = 0.0024, adjusted hazard ratio 2.05, 95% CI 1.29–3.26; SPH, P = 0.029, adjusted hazard ratio 1.36, 95% CI 1.03–1.80). These differences were not observed in elderly patients in the three cohorts. Associations between the other four vital signs and mortality were not different in elderly and non-elderly patients. The interaction of age and hypothermia/fever was significant (P < 0.05).ConclusionsIn septic patients, we found mortality in non-elderly sepsis patients was increased with hypothermia and decreased with fever. However, mortality in elderly patients was not associated with BT. These results illuminate the difference in the inflammatory response of the elderly compared to non-elderly sepsis patients.

【 授权许可】

CC BY