Determinants of temperature abnormalities and influence on outcome of critical illness
Determinants of temperature abnormalities and influence on outcome of critical illness
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DOI：
10.1097/ccm.0b013e31822f061d
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发表时间：
2012-01-01
影响因子：
8.8
通讯作者：
Timsit, Jean-Francois
中科院分区：
文献类型：
--
作者：
Laupland, Kevin B.;Zahar, Jean-Ralph;Timsit, Jean-Francois
目的：了解2000年4月至2010年11月间重症监护病房收治的18岁患者体温异常的发生及其决定因素。接受低温治疗的患者被排除在外。干预措施:没有。测量方法及主要结果：共纳入10962例患者。年龄中位数为63岁（四分位数范围49-76），入院6639例（61%）为男性，入院简化急性生理评分II和序贯性器官衰竭评分中位数分别为39（四分位数范围27-54）和5（四分位数范围3-8）。8237例（75%）患者被分类为内科患者，1507例（14%）患者被分类为非预定手术患者，1218例（11%）患者被分类为预定手术患者。入院时，1046例（10%）患者为轻度低温（35.0-35.9℃），541例（5%）为中度低温（32-35.9℃），72例（1%）为重度低温（39.5℃）。6133例（55%）患者出现体温异常，347例（3%）患者出现混合发热/低体温异常。内科病人发烧的发生率最高，而外科病人体温过低更常见。总体重症监护病房病死率为：10962例中有1944例（18%），6133例中有828例（14%），轻度低温1046例中有235例（22%），中度低温541例中有205例（38%），重度低温72例中有43例（60%），轻度发热2264例中有412例（18%），559例高热117例（21%），347例中有104例（30%）伴有混合温度异常。在逻辑回归分析中控制了混杂变量后，发病时发烧与任何显著增加的死亡风险无关。然而，低温是医学患者死亡的重要独立预测因子。结论：在重症监护病房就诊的患者中，体温异常是常见的。体温过低是与死亡风险增加相关的一个主要的、潜在的可改变因素。（急救医学2012；40:145-151）
Objective: To determine the occurrence and determinants of temperature abnormalities among patients presenting (= 18 yrs) admitted to an intensive care unit between April 2000 and November 2010. Patients undergoing therapeutic hypothermia were excluded.Interventions: None.Measurements and Main Results: A total of 10,962 patients were included. The median age was 63 yrs (interquartile range, 49-76), 6639 (61%) admissions were in males, and the median admission Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores were 39 (interquartile range, 27-54) and 5 (interquartile range, 3-8), respectively. Patients were classified as medical in 8,237 (75%), nonscheduled surgical in 1,507 (14%), and scheduled surgical in 1,218 (11%). At presentation, 1,046 (10%) patients had mild hypothermia (35.0-35.9 degrees C), 541 (5%) had moderate hypothermia (32-35.9 degrees C), 72 (1%) had severe hypothermia (39.5 degrees C). Normothermia was present in 6,133 (55%) and mixed fever/hypothermia abnormalities occurred in 347 (3%) patients overall. Medical patients had the highest occurrence of any fever, whereas hypothermia was more common in surgical patients. The overall intensive care unit case-fatality was 1,944 of 10,962 (18%) and 828 of 6,133 (14%) for normothermia, 235 of 1,046 (22%) for mild hypothermia, 205 of 541 (38%) for moderate hypothermia, 43 of 72 (60%) for severe hypothermia, 412 of 2,264 (18%) for mild fever, 117 of 559 (21%) for high fever, and 104 of 347 (30%) for those with mixed temperature abnormalities. After controlling for confounding variables in logistic regression analyses, fever at presentation was not associated with any significantly increased risk for death. However, hypothermia was a significant independent predictor for death in medical patients.Conclusions: Temperature abnormalities are common among patients presenting to the intensive care unit. Hypothermia is a major, potentially modifiable factor associated with increased risk for death. (Crit Care Med 2012; 40:145-151)