Effects of body temperature on the prognosis of patients with septic shock / 中华危重病急救医学

ABSTRACT

Objective To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock. Methods A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h Tmax, Tmax), lowest temperature (24 h Tmin, Tmin), and the temperature range (24 h Tmax-min, Tmax-min) were aggregated. The area under temperature curve when body temperature was higher than T (A > T), or lower than T (A < T), and area section between T1 and T2 (AT1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis. Results 635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of Tmax, decrease of Tmin, and increase of Tmax-min were risk factors for 21-day mortality [Tmax odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P < 0.001; Tmin OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; Tmax-min OR = 3.258, 95%CI was 1.840-5.471, P < 0.001], while 24 h Tmax, 24 h Tmin and 24 h Tmax-min were not related to prognosis. A < 36.0 ℃ (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A > 38.0 ℃ (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 ℃, for every 1 ℃×hour increase in A > T, the 21-day relative risk of death increased by 4.1%-83.2%. Conclusion When the body temperature of patients with septic shock is lower than 36.0 ℃, or higher than 38.0 ℃, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.