[EngO4-2] Recognition of low body temperature and its association with outcome in bacteremic patients admitted to emergency and critical care center
Introduction: Abnormal body temperature is one of the frequent abnormal vital sign occurring in patients with life-threatening infection. Of those, low body temperature is associated with higher mortality compared with normal or high body temperature. The recognition of the "low body temperature" by healthcare providers, however, might be still insufficient, which possibly leads to delayed diagnostic and therapeutic interventions.
Methods: We have conducted a single-center, retrospective observational study evaluating the frequency, recognition of low body temperature and its association with care process and patients' outcome. Consecutive patients >18 years old admitted to an emergency and critical care center at a university-affiliated hospital and diagnosed with bacteremia/fungemia were enrolled. Patients were divided into three groups by body temperature measured on admission; 1) high (BT 38℃≤, Group H)，2) moderate (BT=36-38℃, Group M) and 3) low (BT<36℃, Group L). All-cause mortality at 28 days was compared. In addition, we assessed the timing of administration for initial empiric therapy specifically in patients diagnosed with infection among the three groups. We also evaluated whether resident doctors who initially cared patients recognized the abnormal (high or low) body temperature.
Results: 233 patients were enrolled; Group H=61(26%)，Group M=142(61%)，Group L=30(13%)．In-hospital mortality was significantly highest in Group L (50%) compared with other groups (Group H= 16%, p=0.0021, and Group M=23%, p=0.0066). Multivariate analysis have shown that the adjusted Odds of dying at 28 days in Group L was 3.65 (95% confidence interval 1.25 to 10.6; p=0.018)．Proportion of patients receiving early administration of antibiotics <1 h was significantly lower in Group L (10%) compared with Group H (38%) and Group M (18%)（p=0.017)．Resident doctors recognized low body temperature as an abnormal sign more infrequently compared with high body temperature.
Conclusions: Hypothermia was a significant factor associated with high in-hospital mortality in critically-ill patients with infection. Underrecognition of low body temperature occurs frequently and might be associated with delayed provision of therapeutic intervention, which might be a factor of the poor outcome.
Methods: We have conducted a single-center, retrospective observational study evaluating the frequency, recognition of low body temperature and its association with care process and patients' outcome. Consecutive patients >18 years old admitted to an emergency and critical care center at a university-affiliated hospital and diagnosed with bacteremia/fungemia were enrolled. Patients were divided into three groups by body temperature measured on admission; 1) high (BT 38℃≤, Group H)，2) moderate (BT=36-38℃, Group M) and 3) low (BT<36℃, Group L). All-cause mortality at 28 days was compared. In addition, we assessed the timing of administration for initial empiric therapy specifically in patients diagnosed with infection among the three groups. We also evaluated whether resident doctors who initially cared patients recognized the abnormal (high or low) body temperature.
Results: 233 patients were enrolled; Group H=61(26%)，Group M=142(61%)，Group L=30(13%)．In-hospital mortality was significantly highest in Group L (50%) compared with other groups (Group H= 16%, p=0.0021, and Group M=23%, p=0.0066). Multivariate analysis have shown that the adjusted Odds of dying at 28 days in Group L was 3.65 (95% confidence interval 1.25 to 10.6; p=0.018)．Proportion of patients receiving early administration of antibiotics <1 h was significantly lower in Group L (10%) compared with Group H (38%) and Group M (18%)（p=0.017)．Resident doctors recognized low body temperature as an abnormal sign more infrequently compared with high body temperature.
Conclusions: Hypothermia was a significant factor associated with high in-hospital mortality in critically-ill patients with infection. Underrecognition of low body temperature occurs frequently and might be associated with delayed provision of therapeutic intervention, which might be a factor of the poor outcome.