Relative tachycardia in patients with sepsis: an independent risk factor for mortality.

BACKGROUND

Excess activation of the sympathetic nervous system may be a risk factor for mortality in patients with the systemic inflammatory response syndrome (SIRS) or sepsis.

AIM

To examine whether excessive tachycardia, relative to the degree of fever is an independent risk factor for death in patients with SIRS.

DESIGN

Prospective observational study.

SETTING

Departments of medicine in three university hospitals in Israel, Germany and Italy.

METHODS

We collected data for 3382 patients with SIRS, whether community- or hospital-acquired, 91% with sepsis, as part of an ongoing trial.

RESULTS

Overall 30-day mortality was 12% (408/3382). The pulse/temperature ratio was significantly higher in patients who died than in survivors: mean +/- SD 2.55 +/- 0.57 vs. 2.40 +/- 0.48 bpm/ degrees C (p < 0.0001). Excessive tachycardia was significantly associated with a mortality in a logistic model accounting for other strong predictors of mortality (OR 1.54, 95%CI 1.10-2.17). Patients with septic shock were the only group for whom this association did not hold.

DISCUSSION

Our data are compatible with the hypothesis that some patients with sepsis experience an excess activation of the sympathetic nervous system, leading to a fatal outcome.