Background
Methods
Study design
Study population
Data collection
Data analysis
Results
Patient characteristics
Characteristics | All patients (n = 6542) | Hypothermia ≤ 35.5 °C (n = 1042) | Normothermia 35.6–37.5 °C (n = 1692) | Mild fever 37.6–39 °C (n = 2550) | High fever ≥ 39.1 °C (n = 1258) | p value |
---|---|---|---|---|---|---|
Age (years) | 70 [59–77] | 72 [60–78] | 77 [61–79] | 70 [58–76] | 67 [55–75] | < 0.001 |
Sex (male) | 4079 (62.4) | 606 (58.2) | 1004 (59.3) | 1635 (64.1) | 834 (66.3) | < 0.001 |
Body mass index | 26.3 [23.4–30.3] | 25,5 [22.5–29.2] | 26.0 [23.0–29.8] | 26.6 [23.9–30.5] | 27,4 [1–34] | < 0.001 |
Origin of infection | < 0.001 | |||||
Community-acquired | 2790 (42.6) | 496 (47.6) | 746 (44.1) | 976 (38.3) | 572 (45.5) | |
Nosocomial (ICU) | 1471 (22.5) | 139 (13.3) | 315 (18.6) | 678 (26.6) | 339 (26.9) | |
Nosocomial (ward) | 2112 (32.3) | 367 (35.2) | 593 (35.0) | 835 (32.7) | 317 (25.2) | |
Nosocomial (nursing home) | 168 (2.6) | 39 (3.7) | 38 (2.2) | 61 (2.4) | 30 (2.4) | |
Focus of infection | ||||||
Respiratory | 2678 (40.9) | 352 (33.8) | 593 (35.0) | 1172 (46.0) | 561 (44.6) | < 0.001 |
Abdominal | 2422 (37.0) | 473 (45.4) | 756 (44.7) | 896 (35.1) | 297 (23.6) | < 0.001 |
Urogenital | 869 (13.3) | 125 (12.0) | 221 (13.1) | 288 (11.3) | 235 (18.7) | < 0.001 |
Bones/soft tissue | 851 (13.0) | 156 (15.0) | 249 (14.7) | 306 (12.0) | 140 (11.1) | 0.003 |
Other | 728 (11.1) | 97 (9.3) | 130 (7.7) | 265 (10.4) | 236 (18.8) | < 0.001 |
Clinical data | ||||||
Pathogen in BC | 2167 (40.6) | 315 (37.5) | 458 (36.2) | 788 (38.2) | 606 (51.6) | < 0.001 |
PCT (ng/ml) | 5.9 [1.6–23.9] | 5.4 [1.6–21.1] | 5.6 [1.6–20.7] | 5.0 [1.3–19.5] | 10.6 [2.2–39.2] | < 0.001 |
CRP (mg/ml) | 204[115–298] | 165 [94–263] | 213 [119–304] | 218 [125–307] | 199 [108–288] | < 0.001 |
WBC (Gpt/l) | 16.0 [10.5–22.9] | 16.8 [10.9–24.5] | 16.6 [11.4–23.8] | 15.7 [10.3–21.9] | 15.2 [9.6–22.4] | < 0.001 |
Leukopenia (WBC ≤ 4) | 703 (10.8) | 119 (11.4) | 159 (9.4) | 264 (10.4) | 161 (12.8) | 0.02 |
Lactate (mmol/l) | 2.6 [1.6–4.8] | 3.8 [1.9–8.4] | 2.5 [1.6–4.5] | 2.4 [1.5–4.2] | 2.5 [1.5–4.4] | < 0.001 |
Urine output (ml/24 h) | 1380 [640–2360] | 920 [260–1840] | 1240 [550–2130] | 1510 [800–2480] | 1710 [850–2640] | < 0.001 |
Heart rate (−1/min) | 119 [100–135] | 116 [100–134] | 113 [96–130] | 119 [101–134] | 124 [110–140] | < 0.001 |
SOFA | 9 [6–11] | 10 [7–12] | 8 [6–11] | 8 [6–11] | 9 [6–11] | < 0.001 |
Septic shock (Sepsis-3 criteria) | 3513 (53,7) | 973 (66,7) | 938 (48,7) | 967 (50,9) | 635 (50,5) | < 0.001 |
Quality of care | ||||||
Blood cultures drawn | 5342 (81.7) | 840 (80.6) | 1266 (74.8) | 2061 (80.8) | 1175 (93.4) | < 0.001 |
Time to antibiotics (min) | 98 [15–305] | 115 [20–305] | 103 [10–350] | 105 [15–320] | 80 [15–240] | 0.02 |
Outcome | ||||||
New onset dialysis | 1502 (23.0) | 368 (35.3) | 374 (22.1) | 538 (19.7) | 222 (20.7) | < 0.001 |
ICU mortality | 1952 (29.9) | 444 (42.7) | 528 (31.3) | 677 (26.6) | 303 (24.1) | < 0.001 |
28-Day mortality | 2024 (31.8) | 467 (45.7) | 539 (32.6) | 693 (28.0) | 325 (26.6) | < 0.001 |
Hospital mortality | 2448 (37.5) | 546 (52.5) | 676 (40.0) | 850 (33.4) | 376 (30.0) | < 0.001 |
Average outside temperature
Predictors of hypothermia, normothermia and fever
Variable | Hypothermia ≤ 36.5 °C | Normothermia 35.6–37.5 °C | Mild fever 37.6–39 °C | High fever ≥ 39.1 °C |
---|---|---|---|---|
Pathogen in BC | 0.96 (0.80–1.17) | 0.79 (0.67–0.93)** | Reference category | 1.74 (1.46–2.08)*** |
Origin of infection | ||||
Community | 1.37 (1.13–1.66)** | 1.09 (0.92–1.28) | 1.34 (1.09–1.65)** | |
ICU | 0.50 (0.39–0.64)*** | 0.66 (0.54–0.80)*** | 1.44 (1.15–1.82)** | |
Ward/nursing home | Reference | Reference | Reference | |
Focus of infection | ||||
Respiratory | 0.72 (0.56–0.92)* | 0.77 (0.62–0.95)* | 0.89 (0.71–1.11) | |
Abdominal | 1.32 (1.04–1.68)* | 1.38 (1.12–1.69)** | 0.44 (0.34–0.56)*** | |
Urogenital | 0.86 (0.59–1.27) | 1.20 (0.88–1.63) | 0.95 (0.69–1.31) | |
Bones/soft tissue | 1.38 (0.99–1.91) | 1.39 (1.05–1.85)* | 0.76 (0.54–1.08) | |
Other/unknown | Reference | Reference | Reference | |
Age (per 10 years) | 1.11 (1.04–1.18)*** | 1.15 (1.09–1.22)*** | 0.87 (0.82–0.92)*** | |
BMI (per 5 points) | 0.82 (0.76–0.87)*** | 0.92 (0.88–0.97)** | 1.03 (0.99–1.08) | |
Procalcitonin log10 | 0.96 (0.85–1.08) | 1.01 (0.92–1.12) | 1.43 (1.28–1.60)*** | |
Mean temperature (per 10 °C) | 0.83 (0.74–0.93)** | 1.01 (0.91–1.11) | 1.12 (0.99–1.25) |