Significance of body temperature in elderly patients with sepsis.
Body temperature
Elderly
Fever
Hypothermia
Septic shock
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
30 06 2020
30 06 2020
Historique:
received:
27
01
2020
accepted:
12
05
2020
entrez:
2
7
2020
pubmed:
2
7
2020
medline:
26
3
2021
Statut:
epublish
Résumé
Elderly 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. This 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). In 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). In 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.
Sections du résumé
BACKGROUND
Elderly 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.
METHODS
This 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).
RESULTS
In 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).
CONCLUSIONS
In 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.
Identifiants
pubmed: 32605659
doi: 10.1186/s13054-020-02976-6
pii: 10.1186/s13054-020-02976-6
pmc: PMC7329464
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
387Investigateurs
Takashi Shimazui
(T)
Taka-Aki Nakada
(TA)
Keith R Walley
(KR)
Taku Oshima
(T)
Toshikazu Abe
(T)
Hiroshi Ogura
(H)
Atsushi Shiraishi
(A)
Shigeki Kushimoto
(S)
Daizoh Saitoh
(D)
Seitaro Fujishima
(S)
Toshihiko Mayumi
(T)
Yasukazu Shiino
(Y)
Takehiko Tarui
(T)
Toru Hifumi
(T)
Yasuhiro Otomo
(Y)
Kohji Okamoto
(K)
Yutaka Umemura
(Y)
Joji Kotani
(J)
Yuichiro Sakamoto
(Y)
Junichi Sasaki
(J)
Shin-Ichiro Shiraishi
(SI)
Kiyotsugu Takuma
(K)
Ryosuke Tsuruta
(R)
Akiyoshi Hagiwara
(A)
Kazuma Yamakawa
(K)
Tomohiko Masuno
(T)
Naoshi Takeyama
(N)
Norio Yamashita
(N)
Hiroto Ikeda
(H)
Masashi Ueyama
(M)
Satoshi Fujimi
(S)
Satoshi Gando
(S)
Osamu Tasaki
(O)
Yasumitsu Mizobata
(Y)
Hiraku Funakoshi
(H)
Toshiro Okuyama
(T)
Iwao Yamashita
(I)
Toshio Kanai
(T)
Yasuo Yamada
(Y)
Mayuki Aibiki
(M)
Keiji Sato
(K)
Susumu Yamashita
(S)
Kenichi Yoshida
(K)
Shunji Kasaoka
(S)
Akihide Kon
(A)
Hiroshi Rinka
(H)
Hiroshi Kato
(H)
Hiroshi Okudera
(H)
Eichi Narimatsu
(E)
Toshifumi Fujiwara
(T)
Manabu Sugita
(M)
Yasuo Shichinohe
(Y)
Hajime Nakae
(H)
Ryouji Iiduka
(R)
Mitsunobu Nakamura
(M)
Yuji Murata
(Y)
Yoshitake Sato
(Y)
Hiroyasu Ishikura
(H)
Yasuhiro Myojo
(Y)
Yasuyuki Tsujita
(Y)
Kosaku Kinoshita
(K)
Hiroyuki Yamaguchi
(H)
Toshihiro Sakurai
(T)
Satoru Miyatake
(S)
Takao Saotome
(T)
Susumu Yasuda
(S)
Toshikazu Abe
(T)
Hiroshi Ogura
(H)
Yutaka Umemura
(Y)
Atsushi Shiraishi
(A)
Shigeki Kushimoto
(S)
Daizoh Saitoh
(D)
Seitaro Fujishima
(S)
Junichi Sasaki
(J)
Toshihiko Mayumi
(T)
Yasukazu Shiino
(Y)
Taka-Aki Nakada
(TA)
Takehiko Tarui
(T)
Toru Hifumi
(T)
Yasuhiro Otomo
(Y)
Joji Kotani
(J)
Yuichiro Sakamoto
(Y)
Shin-Ichiro Shiraishi
(SI)
Kiyotsugu Takuma
(K)
Ryosuke Tsuruta
(R)
Akiyoshi Hagiwara
(A)
Kazuma Yamakawa
(K)
Naoshi Takeyama
(N)
Norio Yamashita
(N)
Hiroto Ikeda
(H)
Yasuaki Mizushima
(Y)
Satoshi Gando
(S)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
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