The association of body temperature with antibiotic therapy and mortality in patients attending the emergency department with suspected infection

Schuttevaer, Romy; Brink, Alec Maassen van den; Alsma, Jelmer; Steenwinkel, Jurriaan E.M. de; Verbon, Annelies; Schuit, Stephanie C. E.; Lingsma, Hester F.

doi:10.1097/mej.0000000000000817

Cited by 10 publications

(17 citation statements)

References 22 publications

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“…Consistent with previous reported detailing the association of BTs and mortality in ED patients, 27 we indicated that afebrile status or hypothermia in bacteraemia adults was corresponding to worse prognoses, compared with that of patients with febrile response at bacteraemia onset. We believe that the favourable prognoses of patients with higher iBTs are attributable to increased humoral and cellular immunity.…”

Section: Discussionsupporting

confidence: 92%

Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures

Ho¹,

Hung²,

Chen³

et al. 2022

IDR

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Purpose To investigate the different impact of delayed administration of appropriate antimicrobial therapy (AAT) on short-term mortality of bacteraemia patients initially presenting with various body temperatures (BTs). Materials and Methods A six-year, two-center cohort consisting of adults with community-onset bacteraemia in emergency departments (EDs) was retrospectively collected. Through the multivariable analyses, clinical impacts of delayed AAT, assessed by the time gap between the first dose of AAT and ED arrival, on 30-day mortality (primary outcomes) were respectively examined in the different groups of initial BTs (iBTs). Results Of the 3171 adults, despite the similarities of delayed AAT in six iBT categories, hourly AAT delay was associated with an average increase in 30-day mortality rates of 0.24% in the group of iBT <36.0℃, 0.40% in the 36.0℃–36.9℃ group, 0.48% in the 37.0℃–37.9℃ group, 0.59% in the 38.0℃–38.9℃ group, 0.58% in the 39.0℃–39.9℃ group, and 0.71% in the ≥40.0℃ group, after respective adjusting independent predictors of mortality. Furthermore, for 589 patients who inappropriately received empirical antimicrobial treatment (ie, delayed AAT ≥ 24 hours), with a cutoff of 34.0℃, each 1℃ increase in iBTs was independently associated with an average increase in 30-day mortality rates of 42%. Conclusion For adults with community-onset bacteraemia, the iBT-related differences in the prognostic impacts of delayed administration of appropriate antimicrobials might be evident.

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Section: Discussionsupporting

confidence: 92%

Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures

Ho¹,

Hung²,

Chen³

et al. 2022

IDR

View full text Add to dashboard Cite

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“…Along these lines, previous ED-based studies showed that hyperthermia and high blood pressure did not seem to be strongly associated with adverse events in the ED. 32,33 We defined an EDICAS of 3-5 as a medium-risk category, which may be used to flag patients needing an urgent physician assessment, particularly those who are initially triaged to lower levels. We also defined an EDICAS of 6 or above as a high-risk category as it corresponded to a specificity of 98% and a positive likelihood ratio of 12.7, both of which could raise the probability PPV, positive predictive value; NPV, negative predictive value; LR+, positive likelihood ratio; LR-, negative likelihood ratio.…”

Section: Discussionmentioning

confidence: 99%

“…Along these lines, previous ED-based studies showed that hyperthermia and high blood pressure did not seem to be strongly associated with adverse events in the ED. 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Novel Triage Tool for Predicting Cardiac Arrest in the Emergency Department

Tsai

Wang

et al. 2022

WestJEM

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Background: Early recognition and prevention of in-hospital cardiac arrest (IHCA) have played an increasingly important role in the chain of survival. However, clinical tools for predicting IHCA are scarce, particularly in the emergency department (ED). We sought to estimate the incidence of ED-based IHCA and to develop and validate a novel triage tool, the Emergency Department In-hospital Cardiac Arrest Score (EDICAS), for predicting ED-based IHCA. Methods: In this retrospective cohort study we used electronic clinical warehouse data from a tertiary medical center with approximately 100,000 ED visits per year. We extracted data from 733,398 ED visits over a seven-year period. We selected one ED visit per person and excluded out-of-hospital cardiac arrest or children. Patient demographics and computerized triage information were included as potential predictors. Results: A total of 325,502 adult ED patients were included. Of these patients, 623 (0.2%) developed ED-based IHCA. The EDICAS, which includes age and arrival mode and categorizes vital signs with simple cut-offs, showed excellent discrimination (area under the receiver operating characteristic [AUROC] curve, 0.87) and maintained its discriminatory ability (AUROC, 0.86) in cross-validation. Previously developed early warning scores showed lower AUROC (0.77 for the Modified Early Warning Score and 0.83 for the National Early Warning Score) when applied to our ED population. Conclusion: In-hospital cardiac arrest in the ED is relatively uncommon. We developed and internally validated a novel tool for predicting imminent IHCA in the ED. Future studies are warranted to determine whether this tool could gain lead time to identify high-risk patients and potentially reduce ED-based IHCA.

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“…Our study further demonstrated that the hypoinflammatory state usually persisted, at least in the ED, and predicted worse outcomes. On the other hand, a study has reported that hyperthermic patients in the ED received more antibiotic therapy, and thus had lower mortality compared with normothermic patients (25).…”

Section: Discussionmentioning

confidence: 98%

Trajectories of Vital Signs and Risk of In-Hospital Cardiac Arrest

Tsai

Wang

et al. 2022

Front. Med.

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Background: Little is known about the trajectories of vital signs prior to in-hospital cardiac arrest (IHCA), which could explain the heterogeneous processes preceding this event. We aimed to identify clinically relevant subphenotypes at high risk of IHCA in the emergency department (ED).Methods: This retrospective cohort study used electronic clinical warehouse data from a tertiary medical center. We retrieved data from 733,398 ED visits over a 7-year period. We selected one ED visit per person and retrieved patient demographics, triage data, vital signs (systolic blood pressure [SBP], heart rate [HR], body temperature, respiratory rate, oxygen saturation), selected laboratory markers, and IHCA status. Group-based trajectory modeling was performed.Results: There were 37,697 adult ED patients with a total of 1,507,121 data points across all vital-sign categories. Three to four trajectory groups per vital-sign category were identified, and the following five trajectory groups were associated with a higher rate of IHCA: low and fluctuating SBP, high and fluctuating HR, persistent hypothermia, recurring tachypnea, and low and fluctuating oxygen saturation. The IHCA-prone trajectory group was associated with a higher triage level and a higher mortality rate, compared to other trajectory groups. Except for the persistent hypothermia group, the other four trajectory groups were more likely to have higher levels of C-reactive protein, lactic acid, cardiac troponin I, and D-dimer. Multivariable analysis revealed that hypothermia (adjusted odds ratio [aOR], 2.20; 95% confidence interval [95%CI], 1.35–3.57) and recurring tachypnea (aOR 2.44; 95%CI, 1.24–4.79) were independently associated with IHCA.Conclusions: We identified five novel vital-sign sub-phenotypes associated with a higher likelihood of IHCA, with distinct patterns in clinical course and laboratory markers. A better understanding of the pre-IHCA vital-sign trajectories may help with the early identification of deteriorating patients.

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The association of body temperature with antibiotic therapy and mortality in patients attending the emergency department with suspected infection

Abstract: Supplemental Digital Content is available in the text.

Cited by 10 publications

References 22 publications

Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures

Prognostic Effects of Delayed Administration of Appropriate Antimicrobials in Bacteraemic Adults Initially Presenting with Various Body Temperatures

Development and Validation of a Novel Triage Tool for Predicting Cardiac Arrest in the Emergency Department

Trajectories of Vital Signs and Risk of In-Hospital Cardiac Arrest

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