Significance of body temperature in elderly patients with sepsis

Takashi Shimazui ,Shigeki Kushimoto ,Toshikazu Abe ,Satoshi Fujimi ,Toshihiko Mayumi ,Kazuma Yamakawa ,Joji Kotani ,Taka‐Aki Nakada ,Atsushi Shiraishi ,Takehiko Tarui ,Taku Oshima ,Kiyotsugu Takuma ,Naoshi Takeyama ,Akiyoshi Hagiwara ,Keith R Walley ,Toru Hifumi ,Shin‐Ichiro Shiraishi ,Kohji Okamoto ,Hiroshi Ogura ,Daizoh Saitoh ,Junichi Sasaki ,Ryosuke Tsuruta ,Hiroto Ikeda ,Tomohiko Masuno ,Seitaro Fujishima ,Yasukazu Shiino ,Yasuhiro Otomo ,Masashi Ueyama ,Yutaka Umemura ,Norio Yamashita ,Yuichiro Sakamoto ,Satoshi Gando

doi:10.1186/s13054-020-02976-6

Abstract

BackgroundElderly patients have a blunted host response, which may influence vital signs and clinical outcomes of sepsis. This study was aimed to investigate whether the associations between the vital signs and mortality are different in elderly and non-elderly patients with sepsis.MethodsThis was a retrospective observational study. A Japanese multicenter sepsis cohort (FORECAST, n = 1148) was used for the discovery analyses. Significant discovery results were tested for replication using two validation cohorts of sepsis (JAAMSR, Japan, n = 624; SPH, Canada, n = 1004). Patients were categorized into elderly and non-elderly groups (age ≥ 75 or < 75 years). We tested for association between vital signs (body temperature [BT], heart rate, mean arterial pressure, systolic blood pressure, and respiratory rate) and 90-day in-hospital mortality (primary outcome).ResultsIn the discovery cohort, non-elderly patients with BT < 36.0 °C had significantly increased 90-day mortality (P = 0.025, adjusted hazard ratio 1.70, 95% CI 1.07–2.71). In the validation cohorts, non-elderly patients with BT < 36.0 °C had significantly increased mortality (JAAMSR, P = 0.0024, adjusted hazard ratio 2.05, 95% CI 1.29–3.26; SPH, P = 0.029, adjusted hazard ratio 1.36, 95% CI 1.03–1.80). These differences were not observed in elderly patients in the three cohorts. Associations between the other four vital signs and mortality were not different in elderly and non-elderly patients. The interaction of age and hypothermia/fever was significant (P < 0.05).ConclusionsIn septic patients, we found mortality in non-elderly sepsis patients was increased with hypothermia and decreased with fever. However, mortality in elderly patients was not associated with BT. These results illuminate the difference in the inflammatory response of the elderly compared to non-elderly sepsis patients.

Highlights

Patients have a blunted host response, which may influence vital signs and clinical outcomes of sepsis
Of the vital sign variables on day 1, elderly patients had significantly lower body temperature (BT) and heart rate (HR) compared to non-elderly patients
Discovery analysis for all vital signs (FORECAST cohort) In the primary analysis of the five vital signs using Cox regression, non-elderly patients with BT < 36.0 °C had a significantly increased hazard of death over 90 days (P = 0.025, adjusted hazard ratio 1.70, 95% CI 1.07–2.71) (Fig. 1, Fig. 2a)

Summary

Introduction

Patients have a blunted host response, which may influence vital signs and clinical outcomes of sepsis. A dysregulated response alters vital signs such as body temperature (BT), heart rate (HR), blood pressure (BP), and respiratory rate (RR) [3, 4]. Alterations such as hypothermia, fever, tachycardia, hypotension, or tachypnea tend to be associated with altered clinical outcomes [5,6,7,8,9]. Whether the relationships between altered vital signs and clinical outcomes differ between elderly and non-elderly patients remains unclear Investigating and clarifying these differences might contribute to improving the quality of sepsis care, reducing mortality rates in critically ill septic patients

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