在急诊科就诊时无发热状态与脓毒症患者抗生素治疗延迟相关（修订版）。

Afebrile status at the time of emergency department visit is associated with delayed antibiotic therapy in patients with sepsis (revised).

机构信息

Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Public Health and Medical Service, Seoul National University Hospital, Seoul, Republic of Korea.

Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Research Center for Disaster Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.

出版信息

Am J Emerg Med. 2024 Sep;83:69-75. doi: 10.1016/j.ajem.2024.06.031. Epub 2024 Jul 2.

DOI:10.1016/j.ajem.2024.06.031

PMID:38976929

Abstract

OBJECTIVES

To determine whether there is a difference in antibiotic administration time and prognosis in afebrile sepsis patients compared to febrile sepsis patients.

METHODS

This was retrospective multicenter observational study. Data collected from three referral hospitals. Data were collected from May 2014 through February 2016 under the SEPSIS-2 criteria and from March 2016 to April 2020 under the newly released SEPSIS-3 criteria. Patients were divided into two groups based on body temperature: afebrile (<37.3 °C) and febrile (≥37.3 °C). The relationship between initial body temperature and 28-day mortality were analyzed using multivariable logistic regression. The subgroup analysis was conducted on patients with complete Hour-1 bundle performance records.

RESULTS

We included 4293 patients in this study. Initial body temperatures in 28-day survivors were significantly higher than in 28-day non-survivors (37.5 °C ± 1.2 °C versus 37.1 °C ± 1.2 °C, p < 0.01). Multivariable logistic regression analysis was performed in afebrile and febrile sepsis patients. Adjusted odds ratio of afebrile sepsis patients for 28-day mortality was 1.76 (95% Confidence interval 1.46-2.12). As a result of performing the Hour-1 bundle, the number of patients who received antibiotics within 1 h was smaller in the afebrile sepsis patients (323/2076, 15.6%) than in the febrile sepsis patients (395/2156, 18.3%) (p = 0.02). In the subgroup analysis of patients with complete Hour-1 bundle performance records adjusted odds ratio of afebrile sepsis patients for 28-day mortality was 1.68 (95% Confidence interval 1.34-2.11). The febrile sepsis patients received antibiotics faster than the afebrile sepsis patients (175.5 ± 207.9 versus 209.3 ± 277.9, p < 0.01).

CONCLUSIONS

Afebrile sepsis patients were associated with higher 28-day mortality compared to their febrile counterparts and were delayed in receiving antibiotics. This underscores the need for improved early detection and treatment strategies for the afebrile sepsis patients.

摘要

目的

比较发热性脓毒症患者与非发热性脓毒症患者的抗生素使用时间和预后是否存在差异。

方法

这是一项回顾性多中心观察性研究。数据来自三家转诊医院。根据 SEPSIS-2 标准于 2014 年 5 月至 2016 年 2 月，根据新发布的 SEPSIS-3 标准于 2016 年 3 月至 2020 年 4 月收集数据。根据体温将患者分为两组：发热（≥37.3°C）和非发热（<37.3°C）。采用多变量逻辑回归分析初始体温与 28 天死亡率的关系。对完成完整第 1 小时治疗包记录的患者进行亚组分析。

结果

本研究共纳入 4293 例患者。28 天存活者的初始体温明显高于 28 天非存活者（37.5°C±1.2°C 比 37.1°C±1.2°C，p<0.01）。对发热性脓毒症患者和非发热性脓毒症患者进行多变量逻辑回归分析。调整后的非发热性脓毒症患者 28 天死亡率的优势比为 1.76（95%置信区间 1.46-2.12）。由于完成第 1 小时治疗包，非发热性脓毒症患者中在 1 小时内接受抗生素治疗的患者比例（323/2076，15.6%）低于发热性脓毒症患者（395/2156，18.3%）（p=0.02）。在完成完整第 1 小时治疗包记录的患者亚组分析中，非发热性脓毒症患者 28 天死亡率的调整优势比为 1.68（95%置信区间 1.34-2.11）。发热性脓毒症患者接受抗生素治疗的速度快于非发热性脓毒症患者（175.5±207.9 比 209.3±277.9，p<0.01）。