PMID- 24028682
OWN - NLM
STAT- MEDLINE
DCOM- 20150417
LR  - 20211021
IS  - 1466-609X (Electronic)
IS  - 1364-8535 (Print)
IS  - 1364-8535 (Linking)
VI  - 17
IP  - 5
DP  - 2013 Sep 12
TI  - Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile 
      adult intensive care unit patients: a case-control study.
PG  - R200
LID - 10.1186/cc12894 [doi]
AB  - INTRODUCTION: Early treatment of sepsis improves survival, but early diagnosis of 
      hospital-acquired sepsis, especially in critically ill patients, is challenging. 
      Evidence suggests that subtle changes in body temperature patterns may be an 
      early indicator of sepsis, but data is limited. The aim of this study was to 
      examine whether abnormal body temperature patterns, as identified by visual 
      examination, could predict the subsequent diagnosis of sepsis in afebrile 
      critically ill patients. METHODS: Retrospective case-control study of 32 septic 
      and 29 non-septic patients in an adult medical and surgical ICU. Temperature 
      curves for the period starting 72 hours and ending 8 hours prior to the clinical 
      suspicion of sepsis (for septic patients) and for the 72-hour period prior to 
      discharge from the ICU (for non-septic patients) were rated as normal or abnormal 
      by seven blinded physicians. Multivariable logistic regression was used to 
      compare groups in regard to maximum temperature, minimum temperature, greatest 
      change in temperature in any 24-hour period, and whether the majority of 
      evaluators rated the curve to be abnormal. RESULTS: Baseline characteristics of 
      the groups were similar except the septic group had more trauma patients (31.3% 
      vs. 6.9%, p = .02) and more patients requiring mechanical ventilation (75.0% vs. 
      41.4%, p = .008). Multivariable logistic regression to control for baseline 
      differences demonstrated that septic patients had significantly larger 
      temperature deviations in any 24-hour period compared to control patients (1.5 degrees C 
      vs. 1.1 degrees C, p = .02). An abnormal temperature pattern was noted by a majority of 
      the evaluators in 22 (68.8%) septic patients and 7 (24.1%) control patients 
      (adjusted OR 4.43, p = .017). This resulted in a sensitivity of 0.69 (95% CI 
      [confidence interval] 0.50, 0.83) and specificity of 0.76 (95% CI 0.56, 0.89) of 
      abnormal temperature curves to predict sepsis. The median time from the 
      temperature plot to the first culture was 9.40 hours (IQR [inter-quartile range] 
      8.00, 18.20) and to the first dose of antibiotics was 16.90 hours (IQR 8.35, 
      34.20). CONCLUSIONS: Abnormal body temperature curves were predictive of the 
      diagnosis of sepsis in afebrile critically ill patients. Analysis of temperature 
      patterns, rather than absolute values, may facilitate decreased time to 
      antimicrobial therapy.
FAU - Drewry, Anne M
AU  - Drewry AM
FAU - Fuller, Brian M
AU  - Fuller BM
FAU - Bailey, Thomas C
AU  - Bailey TC
FAU - Hotchkiss, Richard S
AU  - Hotchkiss RS
LA  - eng
GR  - UL1 TR000448/TR/NCATS NIH HHS/United States
GR  - GM 44118/GM/NIGMS NIH HHS/United States
GR  - GM 55194/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20130912
PL  - England
TA  - Crit Care
JT  - Critical care (London, England)
JID - 9801902
SB  - IM
MH  - Adult
MH  - Aged
MH  - Body Temperature/*physiology
MH  - Case-Control Studies
MH  - Cross Infection/*diagnosis/epidemiology/*physiopathology
MH  - Female
MH  - Humans
MH  - *Intensive Care Units/trends
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Sepsis/*diagnosis/epidemiology/*physiopathology
PMC - PMC3906745
EDAT- 2013/09/14 06:00
MHDA- 2015/04/18 06:00
PMCR- 2013/09/12
CRDT- 2013/09/14 06:00
PHST- 2013/05/13 00:00 [received]
PHST- 2013/09/12 00:00 [accepted]
PHST- 2013/09/14 06:00 [entrez]
PHST- 2013/09/14 06:00 [pubmed]
PHST- 2015/04/18 06:00 [medline]
PHST- 2013/09/12 00:00 [pmc-release]
AID - cc12894 [pii]
AID - 10.1186/cc12894 [doi]
PST - epublish
SO  - Crit Care. 2013 Sep 12;17(5):R200. doi: 10.1186/cc12894.