The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis.
The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis.
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DOI：
10.1186/cc13106
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发表时间：
2013-11-13
期刊：
影响因子：
--
通讯作者：
JAAM Sepsis Registry Study Group
中科院分区：
文献类型：
--
作者：
Kushimoto S;Gando S;Saitoh D;Mayumi T;Ogura H;Fujishima S;Araki T;Ikeda H;Kotani J;Miki Y;Shiraishi S;Suzuki K;Suzuki Y;Takeyama N;Takuma K;Tsuruta R;Yamaguchi Y;Yamashita N;Aikawa N;JAAM Sepsis Registry Study Group
严重败血症患者常出现体温异常(TB)。然而，结核病异常与疾病严重程度之间的关系尚不清楚。这项研究调查了结核病对严重脓毒症患者的疾病严重性和预后的影响。我们招募了624名严重脓毒症患者，并根据他们登记时的结核病将他们分成6类。温度等级(≤35.5℃，35.6~36.5℃，36.6~37.5℃，37.6~38.5℃，38.6~39.5℃，≥39.6°C)根据急性生理学与慢性健康评估II(APACHE II)评分的温度数据。我们比较了不同组之间的患者特征、生理数据和死亡率。在登记当天，≤36.5°C的结核病患者的序贯器官衰竭评估(SOFA)评分显著低于37.5°C的患者。≤为35.5°C的患者APACHE II评分也高于≤为36.5°C的患者，28天病死率和住院死亡率显著高于≤为36.5°C的患者。虽然死亡率与≥37.6C和≤35.5C的参考范围相比与结核病范围无关，但35.6C-36.5C和35.5C的患者28天死亡的相对风险显著更高(优势比分别为2.032和3.096)。当根据有无低温组(≤36.5°C，n = 160)和无低温组(>；36.5°C，n = 464)进行分组时，弥散性血管内凝血(DIC)以及SOFA和APACHE II评分在低温组显著较高。有低温者的28天死亡率和住院死亡率显著高于无低温者(38.1%比17.9%和49.4%比22.6%)。体温过低是28天死亡率的独立预测因子，无论是否存在感染性休克，均可观察到有无体温过低的患者之间的差异。在严重脓毒症患者中，无论是否存在感染性休克，低温(TB≤36.5C)与死亡率和器官衰竭的增加有关。UMIN-CTR ID UMIN000008195
Abnormal body temperatures (Tb) are frequently seen in patients with severe sepsis. However, the relationship between Tb abnormalities and the severity of disease is not clear. This study investigated the impact of Tb on disease severity and outcomes in patients with severe sepsis. We enrolled 624 patients with severe sepsis and grouped them into 6 categories according to their Tb at the time of enrollment. The temperature categories (≤35.5°C, 35.6–36.5°C, 36.6–37.5°C, 37.6–38.5°C, 38.6–39.5°C, ≥39.6°C) were based on the temperature data of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring. We compared patient characteristics, physiological data, and mortality between groups. Patients with Tb of ≤36.5°C had significantly worse sequential organ failure assessment (SOFA) scores when compared with patients with Tb >37.5°C on the day of enrollment. Scores for APACHE II were also higher in patients with Tb ≤35.5°C when compared with patients with Tb >36.5°C. The 28-day and hospital mortality was significantly higher in patients with Tb ≤36.5°C. The difference in mortality rate was especially noticeable when patients with Tb ≤35.5°C were compared with patients who had Tb of >36.5°C. Although mortality did not relate to Tb ranges of ≥37.6°C as compared to reference range of 36.6–37.5°C, relative risk for 28-day mortality was significantly greater in patients with 35.6–36.5°C and ≤35.5°C (odds ratio; 2.032, 3.096, respectively). When patients were divided into groups based on the presence (≤36.5°C, n = 160) or absence (>36.5°C, n = 464) of hypothermia, disseminated intravascular coagulation (DIC) as well as SOFA and APACHE II scores were significantly higher in patients with hypothermia. Patients with hypothermia had significantly higher 28-day and hospital mortality rates than those without hypothermia (38.1% vs. 17.9% and 49.4% vs. 22.6%, respectively). The presence of hypothermia was an independent predictor of 28-day mortality, and the differences between patients with and without hypothermia were observed irrespective of the presence of septic shock. In patients with severe sepsis, hypothermia (Tb ≤36.5°C) was associated with increased mortality and organ failure, irrespective of the presence of septic shock. UMIN-CTR ID UMIN000008195
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影响因子：
8.8
作者：
Laupland, Kevin B.;Zahar, Jean-Ralph;Timsit, Jean-Francois
通讯作者：
Timsit, Jean-Francois
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通讯作者：
Kremsner, PG
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作者：
Levy, MM;Fink, MP;Ramsay, G
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Ramsay, G