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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

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Author(s)
Sunghoon ParkKyeongman JeonDong Kyu OhEun Young ChoiGil Myeong SeongJeongwon HeoYoujin ChangWon Gun KwackByung Ju KangWon-Il ChoiKyung Chan KimSo Young ParkYoon Mi ShinHeung Bum LeeSo Hee ParkSeok Chan KimSang Hyun KwakJae Hwa ChoBeongki KimChae-Man Lim
Keimyung Author(s)
Choi, Won Il
Department
Dept. of Internal Medicine (내과학)
Journal Title
Critical care medicine
Issued Date
2020
Volume
48
Issue
10
Keyword
emergency departmentmortalitynormothermiasepsis bundles
Abstract
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°C] vs normothermia [36–38°C] vs hyperthermia [> 38°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.
Keimyung Author(s)(Kor)
최원일
Publisher
School of Medicine (의과대학)
Citation
Sunghoon Park et al. (2020). Normothermia in Patients With Sepsis Who Present to Emergency Departments Is Associated With Low Compliance With Sepsis Bundles and Increased In-Hospital Mortality Rate. Critical care medicine, 48(10), 1462–1470. doi: 10.1097/CCM.0000000000004493
Type
Article
ISSN
1530-0293
Source
https://journals.lww.com/ccmjournal/Fulltext/2020/10000/Normothermia_in_Patients_With_Sepsis_Who_Present.8.aspx
DOI
10.1097/CCM.0000000000004493
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43046
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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