Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.
Am J Emerg Med. 2024 Oct;84:18-24. doi: 10.1016/j.ajem.2024.07.030. Epub 2024 Jul 22.
Hypothermia is associated with poor outcomes in sepsis patients, and hypothermic sepsis patients exhibit temperature alterations during initial treatment. The objective of this study was to classify hypothermic sepsis patients based on body temperature trajectories and investigate the associations of these patients with 28-day mortality.
This was a retrospective analysis of prospectively collected data from adult sepsis or septic shock patients who visited three emergency departments between August 2014 and December 2019. Hypothermic sepsis was defined as an initial body temperature <36 °C. delta temperature was calculated by subtracting the 0 h body temperature from the 6 h body temperature. We divided the patients into three groups according to delta temperature: Group A (delta temperature ≤ 0), Group B (0 < delta temperature ≤ 1) and Group C (delta temperature > 1). The primary outcome was 28-day mortality, and a multivariable Cox proportional hazards regression model was generated.
Among 7344 patients with sepsis or septic shock, 325 hypothermic patients were included in the analysis, and the overall mortality rate was 36%. While initial body temperature was not different between survivors and nonsurvivors, survivors exhibited a higher body temperature at 6 h. The 28-day mortality rates for Groups A, B and C were 53.1%, 36.0%, and 30.0%, respectively, and Group A had significantly higher mortality than Group C did (p < 0.05). Group C demonstrated a 44.2% decrease in 28-day mortality compared to Group A (adjusted hazard ratio of 0.558; 95% confidence interval of 0.330-0.941).
In hypothermic sepsis patients, an increase of 1 °C or more in body temperature after the initial 6 h is associated with a reduced risk of 28-day mortality.
低温与脓毒症患者的不良预后相关，且低温脓毒症患者在初始治疗期间会出现体温变化。本研究旨在根据体温轨迹对低温脓毒症患者进行分类，并探讨这些患者与 28 天死亡率的关系。
这是一项回顾性分析，纳入了 2014 年 8 月至 2019 年 12 月期间在三个急诊科就诊的成年脓毒症或脓毒性休克患者前瞻性收集的数据。低温脓毒症定义为初始体温＜36℃。delta 温度通过减去 6 h 时的体温减去 0 h 时的体温来计算。我们根据 delta 温度将患者分为三组：A 组（delta 温度≤0）、B 组（0＜delta 温度≤1）和 C 组（delta 温度＞1）。主要结局是 28 天死亡率，并生成了多变量 Cox 比例风险回归模型。
在 7344 例脓毒症或脓毒性休克患者中，纳入了 325 例低温脓毒症患者进行分析，总死亡率为 36%。虽然幸存者和非幸存者的初始体温无差异，但幸存者在 6 h 时的体温更高。A、B 和 C 组的 28 天死亡率分别为 53.1%、36.0%和 30.0%，A 组死亡率明显高于 C 组（p＜0.05）。与 A 组相比，C 组 28 天死亡率降低了 44.2%（调整后的危险比为 0.558；95%置信区间为 0.330-0.941）。
在低温脓毒症患者中，初始 6 h 后体温升高 1℃或以上与降低 28 天死亡率相关。
