Lu Annabel H, Jain Vardhmaan, Chen Po-Han, Churpek Matthew M, Verhoef Philip A, Quyyumi Arshed A, Bhavani Sivasubramanium V
Emory University School of Medicine, Atlanta, GA.
Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA.
Crit Care Explor. 2025 Jul 9;7(7):e1282. doi: 10.1097/CCE.0000000000001282. eCollection 2025 Jul 1.
Body temperature trajectories of infected patients are associated with dynamic clinical and immune responses to infection. Our objective was to evaluate the association between temperature trajectory subphenotypes and cardiac dysfunction determined by echocardiography.
Retrospective cohort study.
Four hospitals within an academic healthcare system from 2016 to 2019.
Adult patients with suspicion of infection who underwent transthoracic echocardiography within 48 hours of admission.
Using a validated model, patients were classified into four temperature trajectory subphenotypes. The primary outcome compared between subphenotypes was left ventricular dysfunction, defined as ejection fraction less than or equal to 50%.
One thousand nine hundred twenty-three hospitalized septic patients were classified into four subphenotypes: "hyperthermic, slow resolvers" (n = 264, 14%), "hyperthermic, fast resolvers" (302, 16%), "normothermic" patients (903, 47%), and "hypothermic" patients (454, 24%). Left ventricular and right ventricular dysfunction was significantly different between subphenotypes. Hypothermic patients exhibited the highest levels of left ventricular dysfunction (208, 46%; p < 0.01) and right ventricular dysfunction (169, 39%; p < 0.01). In the multivariable logistic regression analysis, adjusting for demographics, comorbidities, and severity of illness, membership in the hypothermic group (odds ratio, 2.65; 95% CI, 1.87-3.80; p < 0.01) was associated with significantly reduced left ventricular ejection fraction compared with hyperthermic slow resolvers as reference. Hypothermic patients also had the highest levels of vasopressor use (27%; p < 0.01), inotrope use (11%; p < 0.01), and in-hospital mortality (12%; p < 0.01).
Temperature trajectories in sepsis are significantly associated with cardiac dysfunction, with hypothermic patients having the highest odds ratio of both left and right ventricular dysfunction. Bedside temperature monitoring could be a readily available marker to prompt early echocardiographic assessment, though further studies are needed to validate the relationship.
感染患者的体温轨迹与对感染的动态临床和免疫反应相关。我们的目的是评估体温轨迹亚表型与经超声心动图确定的心脏功能障碍之间的关联。
回顾性队列研究。
2016年至2019年期间一个学术医疗系统内的四家医院。
入院48小时内接受经胸超声心动图检查的疑似感染成年患者。
使用经过验证的模型，将患者分为四种体温轨迹亚表型。亚表型之间比较的主要结局是左心室功能障碍，定义为射血分数小于或等于50%。
1923例住院脓毒症患者被分为四种亚表型：“高热、缓慢缓解者”（n = 264，14%）、“高热、快速缓解者”（302例，16%）、“正常体温”患者（903例，47%）和“低温”患者（454例，24%）。亚表型之间左心室和右心室功能障碍存在显著差异。低温患者左心室功能障碍水平最高（208例，46%；p < 0.01），右心室功能障碍水平最高（169例，39%；p < 0.01）。在多变量逻辑回归分析中，在调整人口统计学、合并症和疾病严重程度后，与作为对照的高热缓慢缓解者相比，低温组（比值比，2.65；95%CI，1.87 - 3.80；p < 0.01）与左心室射血分数显著降低相关。低温患者血管升压药使用率也最高（27%；p < 0.01），强心药使用率最高（11%；p < 0.01），院内死亡率最高（12%；p < 0.01）。
脓毒症中的体温轨迹与心脏功能障碍显著相关，低温患者左心室和右心室功能障碍的比值比最高。床旁体温监测可能是促使早期进行超声心动图评估的一个现成指标，不过还需要进一步研究来验证这种关系。
