Alsalamah Majid, Alrehaili Bashaer, Almoamary Amal, Al-Juad Abdulrahman, Badri Mutasim, El-Metwally Ashraf
Department of Emergency Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
Ann Thorac Med. 2022 Jul-Sep;17(3):159-165. doi: 10.4103/atm.atm_52_22. Epub 2022 Jul 9.
The aim of this study was to identify the optimal oral temperature cut-off value and other factors predictive of sepsis in elderly patients presenting to emergency department.
A hospital-based retrospective study was performed on all elderly patients who presented to the Adult Emergency Department at King Abdulaziz Medical City in Riyadh (January to December 31, 2018).
Of total of 13,856 patients, 2170 (15.7%) were diagnosed with sepsis. The associated area under the curve estimate was 0.73, 95% confidence interval (CI) 0.72-0.74. Body temperature ≥37.3 was found as optimal cut-point with sensitivity = 50.97% and specificity = 87.22% and 82.39% of patients with sepsis will be correctly classified using this cut-off. An increase of 1° in body temperature was associated with an odds ratio of 9.95 (95% CI 8.95-11.06, < 0.0001). Those aged ≥100 years having 11.12 (95% CI 2.29-20.88, < 0.0001) times the likelihood for sepsis diagnosis compared with those aged 60-69 years. People admitted in weather such as winter, spring, or autumn were more likely to develop sepsis than people admitted in summer.
The risk factors of sepsis such as age, temperature, and seasonal variation inform important evidence-based decisions. The hospitals dealing with sepsis patients should assess older patients for other severe illnesses or co-morbid that might lead to sepsis if left untreated. Therefore, older patients need to be prioritized over younger patients. The body temperature of patients admitted to hospitals needs to be monitored critically and it is important to consider seasonal fluctuations while managing cases of sepsis and allocating resources. Our findings suggest that clinicians should explore the possibility of sepsis in elderly patients admitted to emergency units with oral temperature ≥37.3°C. Risk factors for sepsis reported in this study could inform evidence-based decisions.
本研究的目的是确定急诊科老年患者脓毒症的最佳口腔温度临界值及其他预测因素。
对利雅得阿卜杜勒阿齐兹国王医疗城成人急诊科的所有老年患者进行了一项基于医院的回顾性研究（2018年1月1日至12月31日）。
在总共13856名患者中，2170名（15.7%）被诊断为脓毒症。曲线下面积估计值为0.73，95%置信区间（CI）为0.72 - 0.74。体温≥37.3℃被确定为最佳切点，敏感性为50.97%，特异性为87.22%，使用该切点可正确分类82.39%的脓毒症患者。体温每升高1℃，比值比为9.95（95%CI 8.95 - 11.06，P < 0.0001）。与60 - 69岁的患者相比，年龄≥100岁的患者脓毒症诊断可能性高11.12倍（95%CI 2.29 - 20.88，P < 0.0001）。在冬季、春季或秋季入院的患者比夏季入院的患者更易发生脓毒症。
年龄、体温和季节变化等脓毒症危险因素为重要的循证决策提供了依据。处理脓毒症患者的医院应对老年患者评估是否存在其他严重疾病或合并症，若不治疗可能导致脓毒症。因此，老年患者应优先于年轻患者。需密切监测入院患者的体温，在处理脓毒症病例和分配资源时考虑季节波动很重要。我们的研究结果表明，临床医生应探讨口腔温度≥37.3℃入住急诊科的老年患者发生脓毒症的可能性。本研究报告的脓毒症危险因素可为循证决策提供依据。
