Normothermia in Patients With Sepsis Who Present to Emergency Departments Is Associated With Low Compliance With Sepsis Bundles and Increased In-Hospital Mortality Rate*

Abstract

Objectives: To investigate the impact of normothermia on compliance with sepsis bundles and in-hospital mortality in patients with sepsis who present to emergency departments. Design: Retrospective multicenter observational study. Patients: Nineteen university-affiliated hospitals of the Korean Sepsis Alliance participated in this study. Data were collected regarding patients who visited emergency departments for sepsis during the 1-month period. The patients were divided into three groups based on their body temperature at the time of triage in the emergency department (i.e., hypothermia [< 36°C] vs normothermia [36–38°C] vs hyperthermia [> 38°C]). Interventions: None. Measurements and Main Results: Of 64,021 patients who visited emergency departments, 689 with community-acquired sepsis were analyzed (182 hyperthermic, 420 normothermic, and 87 hypothermic patients). The rate of compliance with the total hour-1 bundle was lowest in the normothermia group (6.0% vs 9.3% in hyperthermia vs 13.8% in hypothermia group; p = 0.032), the rate for lactate measurement was lowest in the normothermia group (62.1% vs 73.1% vs 75.9%; p = 0.005), and the blood culture rate was significantly lower in the normothermia than in the hyperthermia group (p < 0.001). The in-hospital mortality rates in the hyperthermia, normothermia, and hypothermia groups were 8.5%, 20.6%, and 30.8%, respectively (p < 0.001), but there was no significant association between compliance with sepsis bundles and in-hospital mortality. However, in a multivariate analysis, compared with hyperthermia, normothermia was significantly associated with an increased in-hospital mortality (odds ratio, 2.472; 95% CI, 1.005–6.080). This association remained significant even after stratifying patients by median lactate level. Conclusions: Normothermia at emergency department triage was significantly associated with an increased risk of in-hospital mortality and a lower rate of compliance with the sepsis bundle. Despite several limitations, our findings suggest a need for new strategies to improve sepsis outcomes in this group of patients.

Cluster analysis integrating age and body temperature for mortality in patients with sepsis: a multicenter retrospective study

“…In agreement with a previous study, our analysis showed that the 90-day mortality rate was inversely correlated with BT groups among sepsis patients 5 – 7 . Hyperthermia was perceived as an adaptive physiological response, whereas hypothermia was thought to be associated with poor outcomes because it was a maladaptive response 14 .…”

“…Park et al further subdivided sepsis into three BT groups, i.e., hypothermic (< 36 °C), normothermic (36–38 °C), and hyperthermic (> 38 °C) groups. In-hospital mortality rates and BT were inversely correlated (30.8%, 20.6%, and 8.5% in the three BT groups, respectively; p < 0.001) 5 . However, mortality rates according to these three BT groups have not been investigated in older sepsis patient.…”

Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study

“…Patients were enrolled from 19 participating hospitals between September 2019 and December 2020. The protocols for patient enrollment and data collection have been described previously [ 18 ]. Patients were included if they were 19 years old and diagnosed with sepsis or septic shock in the emergency department.…”

Time-To-Antibiotics and Clinical Outcomes in Patients With Sepsis and Septic Shock: A Prospective Nationwide Multicenter Cohort Study

“…Patients were enrolled from 19 participating hospitals between September 2019 and December 2020. The protocols for patient enrollment and data collection have been described previously [17].…”