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Normothermia in Patients With Sepsis Who Present to Emergency Departments Is Associated With Low Compliance With Sepsis Bundles and Increased In-Hospital Mortality Rate*

  • 주제(키워드) emergency department , mortality , normothermia , sepsis bundles
  • 주제(기타) Critical Care Medicine
  • 설명문(일반) [Park, Sunghoon] Hallym Univ Sacred Heart Hosp, Dept Pulm Allergy & Crit Care Med, Anyang, South Korea; [Jeon, Kyeongman] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Crit Care Med, Seoul, South Korea; [Oh, Dong Kyu; Lim, Chae-Man] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Pulm & Crit Care Med, Seoul, South Korea; [Choi, Eun Young] Yeungnam Univ, Med Ctr, Dept Internal Med, Div Resp & Crit Care Med, Daegu, South Korea; [Seong, Gil Myeong] Jeju Natl Univ, Sch Med, Jeju Natl Univ Hosp, Dept Internal Med, Jeju, South Korea; [Heo, Jeongwon] Kangwon Natl Univ Hosp, Dept Internal Med, Chunchon, South Korea; [Chang, Youjin] Inje Univ, Sanggye Paik Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Seoul, South Korea; [Kwack, Won Gun] Kyung Hee Univ Hosp, Dept Internal Med, Div Pulm Allergy & Crit Care Med, Seoul, South Korea; [Kang, Byung Ju] Univ Ulsan, Coll Med, Ulsan Univ Hosp, Dept Internal Med, Ulsan, South Korea; [Choi, Won-Il] Keimyung Univ, Dongsan Med Ctr, Dept Med, Daegu, South Korea; [Kim, Kyung Chan] Daegu Catholic Univ, Coll Med, Daegu Catholic Univ Hosp, Dept Internal Med, Daegu, South Korea; [Park, So Young] Ewha Womens Univ Seoul Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Seoul, South Korea; [Shin, Yoon Mi] Chungbuk Natl Univ, Coll Med, Dept Internal Med, Div Pulm & Crit Care Med, Cheongju, South Korea; [Shin, Yoon Mi] Chungbuk Natl Univ Hosp, Cheongju, South Korea; [Lee, Heung Bum] Chonbuk Natl Univ, Sch Med, Res Ctr Pulm Disorders, Dept Internal Med, Jeonju, South Korea; [Park, So Hee] Inje Univ Ilsan Paik Hosp, Goyang, South Korea; [Kim, Seok Chan] Catholic Univ Korea, Seoul St Marys Hosp, Div Pulm & Crit Care Med, Dept Med, Seoul, South Korea; [Kwak, Sang Hyun] Chonnam Natl Univ Hosp, Dept Anesthesiol, Gwangju, South Korea; [Cho, Jae Hwa] Yonsei Univ, Coll Med, Gangnam Severance Hosp, Dept Internal Med, Seoul, South Korea; [Kim, Beongki] Korea Univ Ansan Hosp, Dept Internal Med, Div Pulmonol, Ansan, South Korea
  • 등재 SCIE, SCOPUS
  • 발행기관 LIPPINCOTT WILLIAMS & WILKINS
  • 발행년도 2020
  • 총서유형 Journal
  • URI http://www.dcollection.net/handler/ewha/000000174617
  • 본문언어 영어
  • Published As http://dx.doi.org/10.1097/CCM.0000000000004493
  • PubMed https://pubmed.ncbi.nlm.nih.gov/32931189

초록/요약

Objectives: To investigate the impact of normothermia on compliance with sepsis bundles and in-hospital mortality in patients with sepsis who present to emergency departments. Design: Retrospective multicenter observational study. Patients: Nineteen university-affiliated hospitals of the Korean Sepsis Alliance participated in this study. Data were collected regarding patients who visited emergency departments for sepsis during the 1-month period. The patients were divided into three groups based on their body temperature at the time of triage in the emergency department (i.e., hypothermia [< 36 degrees C] vs normothermia [36-38 degrees C] vs hyperthermia [> 38 degrees C]). Interventions: None. Measurements and Main Results: Of 64,021 patients who visited emergency departments, 689 with community-acquired sepsis were analyzed (182 hyperthermic, 420 normothermic, and 87 hypothermic patients). The rate of compliance with the total hour-1 bundle was lowest in the normothermia group (6.0% vs 9.3% in hyperthermia vs 13.8% in hypothermia group;p= 0.032), the rate for lactate measurement was lowest in the normothermia group (62.1% vs 73.1% vs 75.9%;p= 0.005), and the blood culture rate was significantly lower in the normothermia than in the hyperthermia group (p< 0.001). The in-hospital mortality rates in the hyperthermia, normothermia, and hypothermia groups were 8.5%, 20.6%, and 30.8%, respectively (p< 0.001), but there was no significant association between compliance with sepsis bundles and in-hospital mortality. However, in a multivariate analysis, compared with hyperthermia, normothermia was significantly associated with an increased in-hospital mortality (odds ratio, 2.472; 95% CI, 1.005-6.080). This association remained significant even after stratifying patients by median lactate level. Conclusions: Normothermia at emergency department triage was significantly associated with an increased risk of in-hospital mortality and a lower rate of compliance with the sepsis bundle. Despite several limitations, our findings suggest a need for new strategies to improve sepsis outcomes in this group of patients.

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