J Korean Soc Emerg Med.  2020 Aug;31(4):346-354.

Association between body temperature measured at the emergency department with prognosis in septic shock patients

Affiliations
  • 1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 3Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
  • 4Department of Emergency Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 5Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 6Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 7Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
  • 8Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
  • 9Department of Emergency Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
  • 10Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea

Abstract


Objective
Prior studies have explored the relationship between initial body temperature (BT) and mortality in patients with sepsis in the emergency department (ED). However, there has been no study on whether or not changes in BT are associated with prognosis in these patients. We hypothesize that BT measured upon ED arrival and septic shock registry enroll time are related to the prognosis of patients with septic shock.
Methods
We conducted a prospective, observational, registry-based study. Each patient was assigned to 1 of 4 groups according to BT upon ED arrival and registry enrollment. Odds ratios for 28-day mortality according to the patient group were estimated using multivariable logistic regression. We also conducted logistic regression sensitivity analysis, except for patients whose time interval between arrival and enrollment was less than 1 hour.
Results
A total of 2,138 patients with septic shock were included. The 28-day mortalities were 13.7%, 11.2%, 13.0%, and 25.8% in groups 1, 2, 3, and 4, respectively (P<0.001). After adjusting for age, sex, mean atrial pressure, respiratory rate, Sequential Organ Failure Assessment score, lactate concentration, comorbidity, and suspicious infection focus, the risk of mortality was significantly low in patients from group 1 (adjusted odds ratio [aOR], 0.433; 95% confidence interval [CI], 0.310-0.604) and group 2 (aOR, 0.540; 95% CI, 0.336-0.868) compared with group 4. In the sensitivity analysis, group based on BT measured upon ED arrival and registry enrollment also remained an independent predictor of mortality.
Conclusion
Afebrile status upon ED arrival and registry enrollment were strongly associated with higher 28-day mortality in patients with septic shock.

Keyword

Septic shock; Body temperature; Mortality; Emergency department
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