Lath Vrinda, Ravindra Prithvishree, Sirur Freston Marc, Bhat Rachana, Bhat Avinash, Naik Karthik, R Ramya, Balakrishnan Jayaraj Mymbilly
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, 576104, Karnataka, India.
Department of Emergency Medical Technology, Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, India.
Int J Emerg Med. 2025 May 7;18(1):93. doi: 10.1186/s12245-025-00890-8.
Sepsis is a disease affecting microcirculation, reflected in temperature changes between the core and the skin. This study explores correlation of this gradient using infrared thermography (IRT) with mortality and markers of hypoperfusion in patients admitted with sepsis and septic shock and its changes with resuscitation.
We conducted a prospective, single center observational study on patients admitted in the Department of Emergency Medicine of a tertiary care center in Karnataka, India. These patients were enrolled based on the inclusion criteria and infrared thermography was performed and cases were followed up after 28 days. Adults presenting to the emergency medicine department with clinically suspected sepsis or septic shock were enrolled and infrared thermography was performed. A final sample size of 187 cases was analyzed after retrospectively excluding patients with any exclusion criteria.
Patients underwent thermal imaging of all four limbs on arrival and after 3 hours of resuscitation. Core temperature was measured using a tympanic thermometer. Infrared thermography was performed, and limb temperature was extracted from the images. Other parameters including mean arterial pressure and lactate were recorded and SOFA score was calculated.
OUTCOME MEASURE(S): The temperature gradients were correlated with 7 and 28-day mortality along with markers of hypoperfusion including mean arterial pressure and serum lactate levels.
A total of 187 patients were included, with a mean SOFA score of 5. Forty four patients (23.5%) died within 7-days. 28-day mortality was 31%. Temperature gradients of core to knee > 8.85°F (p = 0.003) and core to great toe > 12.25°F (p = 0.020) on arrival were found to be correlated with 7-day mortality. Core to knee temperature gradient was found to correlate with 48-hour mortality(p < 0.013). Core to index finger gradient on arrival correlated with vasopressor requirement within 48h (p = 0.020). Core to index finger temperature gradient had a negative correlation with mean arterial pressure (spearman coefficient - 0.286, p = < 0.001), and a positive correlation with lactate (0.281, p = < 0.001), SOFA score (0.242, p = 0.001), qSOFA score (0.167, p = 0.023).
Core-to-knee and core-to-toe temperature gradients using IRT significantly correlate with 7-day mortality. IRT can be a useful adjunct to predict clinical courses in patients with sepsis and septic shock.
脓毒症是一种影响微循环的疾病，可通过核心体温与体表温度的变化反映出来。本研究旨在探讨利用红外热成像（IRT）技术测量的这种温度梯度与脓毒症和脓毒性休克患者死亡率及低灌注标志物之间的相关性，以及复苏过程中这些指标的变化情况。
我们在印度卡纳塔克邦一家三级医疗中心的急诊科对患者进行了一项前瞻性、单中心观察性研究。根据纳入标准招募这些患者，进行红外热成像检查，并在28天后对病例进行随访。纳入在急诊科就诊且临床怀疑为脓毒症或脓毒性休克的成年患者，并进行红外热成像检查。在回顾性排除有任何排除标准的患者后，最终分析了187例样本。
患者在入院时及复苏3小时后对四肢进行热成像检查。使用鼓膜温度计测量核心体温。进行红外热成像检查，并从图像中提取肢体温度。记录包括平均动脉压和乳酸在内的其他参数，并计算序贯器官衰竭评估（SOFA）评分。
温度梯度与7天和28天死亡率以及包括平均动脉压和血清乳酸水平在内的低灌注标志物相关。
共纳入187例患者，平均SOFA评分为5分。44例患者（23.5%）在7天内死亡。28天死亡率为31%。入院时核心体温与膝关节温度梯度>8.85°F（p = 0.003）以及核心体温与大脚趾温度梯度>12.25°F（p = 0.020）与7天死亡率相关。发现核心体温与膝关节温度梯度与48小时死亡率相关（p < 0.013）。入院时核心体温与食指温度梯度与48小时内血管升压药的使用需求相关（p = 0.020）。核心体温与食指温度梯度与平均动脉压呈负相关（斯皮尔曼系数-0.286，p = < 0.001），与乳酸呈正相关（0.281，p = < 0.001），与SOFA评分呈正相关（0.242，p = 0.001），与快速序贯器官衰竭评估（qSOFA）评分呈正相关（0.167，p = 0.023）。
利用IRT测量的核心体温与膝关节、核心体温与脚趾的温度梯度与7天死亡率显著相关。IRT可作为预测脓毒症和脓毒性休克患者临床病程的有用辅助手段。
