Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study.
Kushimoto, Shigeki MD, PhD 1; Abe, Toshikazu MD, PhD 2,3; Ogura, Hiroshi MD, PhD 4; Shiraishi, Atsushi MD, PhD 5; Saitoh, Daizoh MD, PhD 6; Fujishima, Seitaro MD, PhD 7; Mayumi, Toshihiko MD, PhD 8; Hifumi, Toru MD, PhD 9; Shiino, Yasukazu MD, PhD 10; Nakada, Taka-aki MD, PhD 11; Tarui, Takehiko MD, PhD 12; Otomo, Yasuhiro MD, PhD 13; Okamoto, Kohji MD, PhD 14; Umemura, Yutaka MD, PhD 4; Kotani, Joji MD, PhD 15; Sakamoto, Yuichiro MD, PhD 16; Sasaki, Junichi MD, PhD 17; Shiraishi, Shin-ichiro MD, PhD 18; Takuma, Kiyotsugu MD, PhD 19; Tsuruta, Ryosuke MD, PhD 20; Hagiwara, Akiyoshi MD, PhD 21; Yamakawa, Kazuma MD, PhD 22; Masuno, Tomohiko MD, PhD 23; Takeyama, Naoshi MD, PhD 24; Yamashita, Norio MD, PhD 25; Ikeda, Hiroto MD, PhD 26; Ueyama, Masashi MD, PhD 27; Fujimi, Satoshi MD, PhD 22; Gando, Satoshi MD, PhD 28; on behalf of JAAM Focused Outcome Research on Emergency Care for Acute respiratory distress syndrome, Sepsis and Trauma (FORECAST) Group
Critical Care Medicine.
47(5):691-699, May 2019.
(Format: HTML, PDF)
Objectives: To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.
Design: Retrospective sub-analysis.
Setting: Fifty-nine ICUs in Japan, from January 2016 to March 2017.
Patients: Adult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature < 36[degrees]C, 36-38[degrees]C, > 38[degrees]C), using the core body temperature at ICU admission.
Measurements and Main Results: Compliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36[degrees]C, 36-38[degrees]C, and greater than 38[degrees]C, respectively. Hypothermia-body temperature less than 36[degrees]C-was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36-38[degrees]C or greater than 38[degrees]C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38[degrees]C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36[degrees]C than in those with body temperature greater than 38[degrees]C. Implementation rate of the entire 3-hour resuscitation bundle vasopressor use remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38[degrees]C was 1.760 (95% CI, 1.134-2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia.
Conclusions: Hypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.
Copyright (C) by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.