Significance of body temperature in elderly patients with sepsis
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RESEARCH
Open Access
Significance of body temperature in elderly patients with sepsis Takashi Shimazui1, Taka-aki Nakada1* , Keith R. Walley2, Taku Oshima1, Toshikazu Abe3,4, Hiroshi Ogura5, Atsushi Shiraishi6, Shigeki Kushimoto7, Daizoh Saitoh8, Seitaro Fujishima9, Toshihiko Mayumi10, Yasukazu Shiino11, Takehiko Tarui12, Toru Hifumi13, Yasuhiro Otomo14, Kohji Okamoto15, Yutaka Umemura5, Joji Kotani16, Yuichiro Sakamoto17, Junichi Sasaki18, Shin-ichiro Shiraishi19, Kiyotsugu Takuma20, Ryosuke Tsuruta21, Akiyoshi Hagiwara22, Kazuma Yamakawa23, Tomohiko Masuno24, Naoshi Takeyama25, Norio Yamashita26, Hiroto Ikeda27, Masashi Ueyama28, Satoshi Fujimi23, Satoshi Gando29,30, on behalf of the JAAM FORECAST Group
Abstract 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 nonelderly 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. Keywords: Septic shock, Elderly, Body temperature, Fever, Hypothermia
* Correspondence: [email protected] 1 Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba 260-8677, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which per
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