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Significance of body temperature in elderly patients with sepsis

Shimazui, Takashi ; Nakada, Taka-aki ; Walley, Keith R. ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Critical Care Vol. 24, No. 1 ( 2020-12)

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In: Critical Care, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2020-12)

Abstract: 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 non-elderly 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.

Type of Medium: Online Resource

ISSN: 1364-8535

URL: Article

DOI: 10.1186/s13054-020-02976-6

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

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Role of disseminated intravascular coagulation in severe sepsis

Gando, Satoshi ; Shiraishi, Atsushi ; Yamakawa, Kazuma ; [et al.]

Elsevier BV ; 2019

In: Thrombosis Research Vol. 178 ( 2019-06), p. 182-188

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In: Thrombosis Research, Elsevier BV, Vol. 178 ( 2019-06), p. 182-188

Type of Medium: Online Resource

ISSN: 0049-3848

URL: Article

DOI: 10.1016/j.thromres.2019.04.025

Language: English

Publisher: Elsevier BV

Publication Date: 2019

detail.hit.zdb_id: 1500780-7

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3

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Impact of Body Temperature Abnormalities on the Implementation of Sepsis Bundles and Outcomes in Patients With Severe Sepsis: A Retrospective Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study

Kushimoto, Shigeki ; Abe, Toshikazu ; Ogura, Hiroshi ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2019

In: Critical Care Medicine Vol. 47, No. 5 ( 2019-05), p. 691-699

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In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 5 ( 2019-05), p. 691-699

Abstract: To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients. Design: Retrospective sub-analysis. Setting: Fifty-nine ICUs in Japan, from January 2016 to March 2017. Patients: Adult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature 〈 36°C, 36–38°C, 〉 38°C), using the core body temperature at ICU admission. Interventions: None. Measurements and Main Results: Compliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36°C, 36–38°C, and greater than 38°C, respectively. Hypothermia—body temperature less than 36°C—was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36–38°C or greater than 38°C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38°C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36°C than in those with body temperature greater than 38°C. Implementation rate of the entire 3-hour resuscitation bundle + vasopressor use + remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38°C was 1.760 (95% CI, 1.134–2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia. Conclusions: Hypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.

Type of Medium: Online Resource

ISSN: 0090-3493

URL: Article

DOI: 10.1097/CCM.0000000000003688

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2019

detail.hit.zdb_id: 2034247-0

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4

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Association of frailty on treatment outcomes among patients with suspected infection treated at emergency departments

Ishikawa, Shigeto ; Miyagawa, Ippei ; Kusanaga, Masashi ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: European Journal of Emergency Medicine Vol. 28, No. 4 ( 2021-08), p. 285-291

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In: European Journal of Emergency Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 4 ( 2021-08), p. 285-291

Abstract: The clinical frailty scale (CFS) score has been validated as a predictor of adverse outcomes in community-dwelling older people. Older people are at a higher risk of sepsis and have a higher mortality rate. However, the association of frailty on outcomes in patients with sepsis has not been completely examined. Objective This study evaluated the association between CFS and outcomes in patients with sepsis. Design This was a multicenter prospective cohort substudy. Settings and participants The study included 37 emergency departments from across Japan. The patients (age ≥16 years) were included in this study if they had suspected infection at an emergency department during December 2017–February 2018. Outcome measure and analysis The primary outcome was 28-day mortality, stratified by the CFS score categories. The secondary outcomes were the duration of hospital stay, number of ICU-free days (ICUFDs) and number of ventilator-free days (VFDs). Main results A total of 917 patients were included. The median age was 79 years. The CFS score was associated with an increased risk of 28-day mortality and with a higher likelihood of long-term hospital stay and short-term VFDs and ICUFDs. Multivariate logistic regression analysis indicated that the CFS score was a predictor of 28-day mortality [odds ratio (OR), 1.26; 95% confidence interval (CI), 1.11–1.42]. Conclusions This study reported that in patients with suspected sepsis in the emergency department, frailty may be associated with poor prognosis and length of hospital stay.

Type of Medium: Online Resource

ISSN: 0969-9546

URL: Article

DOI: 10.1097/MEJ.0000000000000788

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 2028878-5

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5

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Implementation of earlier antibiotic administration in patients with severe sepsis and septic shock in Japan: a descriptive analysis of a prospective observational study

Abe, Toshikazu ; on behalf of JAAM FORECAST group ; Kushimoto, Shigeki ; [et al.]

Springer Science and Business Media LLC ; 2019

In: Critical Care Vol. 23, No. 1 ( 2019-12)

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In: Critical Care, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2019-12)

Abstract: Time to antibiotic administration is a key element in sepsis care; however, it is difficult to implement sepsis care bundles. Additionally, sepsis is different from other emergent conditions including acute coronary syndrome, stroke, or trauma. We aimed to describe the association between time to antibiotic administration and outcomes in patients with severe sepsis and septic shock in Japan. Methods This prospective observational study enrolled 1184 adult patients diagnosed with severe sepsis based on the Sepsis-2 criteria and admitted to 59 intensive care units (ICUs) in Japan between January 1, 2016, and March 31, 2017, as the sepsis cohort of the Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study. We compared the characteristics and in-hospital mortality of patients administered with antibiotics at varying durations after sepsis recognition, i.e., 0–60, 61–120, 121–180, 181–240, 241–360, and 361–1440 min, and estimated the impact of antibiotic timing on risk-adjusted in-hospital mortality using the generalized estimating equation model (GEE) with an exchangeable, within-group correlation matrix, with “hospital” as the grouping variable. Results Data from 1124 patients in 54 hospitals were used for analyses. Of these, 30.5% and 73.9% received antibiotics within 1 h and 3 h, respectively. Overall, the median time to antibiotic administration was 102 min [interquartile range (IQR), 55–189]. Compared with patients diagnosed in the emergency department [90 min (IQR, 48–164 min)] , time to antibiotic administration was shortest in patients diagnosed in ICUs [60 min (39–180 min)] and longest in patients transferred from wards [120 min (62–226)] . Overall crude mortality was 23.4%, where patients in the 0–60 min group had the highest mortality (28.0%) and a risk-adjusted mortality rate [28.7% (95% CI 23.3–34.1%)], whereas those in the 61–120 min group had the lowest mortality (20.2%) and risk-adjusted mortality rates [21.6% (95% CI 16.5–26.6%)] . Differences in mortality were noted only between the 0–60 min and 61–120 min groups. Conclusions We could not find any association between earlier antibiotic administration and reduction in in-hospital mortality in patients with severe sepsis.

Type of Medium: Online Resource

ISSN: 1364-8535

URL: Article

DOI: 10.1186/s13054-019-2644-x

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2019

detail.hit.zdb_id: 2051256-9

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6

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The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis

Kushimoto, Shigeki ; Gando, Satoshi ; Saitoh, Daizoh ; [et al.]

Springer Science and Business Media LLC ; 2013

In: Critical Care Vol. 17, No. 6 ( 2013), p. R271-

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In: Critical Care, Springer Science and Business Media LLC, Vol. 17, No. 6 ( 2013), p. R271-

Type of Medium: Online Resource

ISSN: 1364-8535

URL: Article

DOI: 10.1186/cc13106

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2013

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Assessment of mortality by qSOFA in patients with sepsis outside ICU: A post hoc subgroup analysis by the Japanese Association for Acute Medicine Sepsis Registry Study Group

Umemura, Yutaka ; Ogura, Hiroshi ; Gando, Satoshi ; [et al.]

Elsevier BV ; 2017

In: Journal of Infection and Chemotherapy Vol. 23, No. 11 ( 2017-11), p. 757-762

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In: Journal of Infection and Chemotherapy, Elsevier BV, Vol. 23, No. 11 ( 2017-11), p. 757-762

Type of Medium: Online Resource

ISSN: 1341-321X

URL: Article

DOI: 10.1016/j.jiac.2017.07.005

Language: English

Publisher: Elsevier BV

Publication Date: 2017

detail.hit.zdb_id: 1481768-8

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8

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Association between low body mass index and increased 28-day mortality of severe sepsis in Japanese cohorts

Oami, Takehiko ; Karasawa, Satoshi ; Shimada, Tadanaga ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Scientific Reports Vol. 11, No. 1 ( 2021-01-15)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-01-15)

Abstract: Current research regarding the association between body mass index (BMI) and altered clinical outcomes of sepsis in Asian populations is insufficient. We investigated the association between BMI and clinical outcomes using two Japanese cohorts of severe sepsis (derivation cohort, Chiba University Hospital, n = 614; validation cohort, multicenter cohort, n = 1561). Participants were categorized into the underweight (BMI 〈 18.5) and non-underweight (BMI ≥ 18.5) groups. The primary outcome was 28-day mortality. Univariate analysis of the derivation cohort indicated increased 28-day mortality trend in the underweight group compared to the non-underweight group (underweight 24.4% [20/82 cases] vs. non-underweight 16.0% [85/532 cases] ; p = 0.060). In the primary analysis, multivariate analysis adjusted for baseline imbalance revealed that patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group ( p = 0.031, adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.06–3.46). In a repeated analysis using a multicenter validation cohort (underweight n = 343, non-underweight n = 1218), patients in the underweight group had a significantly increased 28-day mortality compared to those in the non-underweight group ( p = 0.045, OR 1.40, 95% CI 1.00–1.97). In conclusion, patients with a BMI 〈 18.5 had a significantly increased 28-day mortality compared to those with a BMI ≥ 18.5 in Japanese cohorts with severe sepsis.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-020-80284-3

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

detail.hit.zdb_id: 2615211-3

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9

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Impact of serum glucose levels on disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis

Kushimoto, Shigeki ; Gando, Satoshi ; Saitoh, Daizoh ; [et al.]

Wiley ; 2015

In: Acute Medicine & Surgery Vol. 2, No. 1 ( 2015-01), p. 21-28

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In: Acute Medicine & Surgery, Wiley, Vol. 2, No. 1 ( 2015-01), p. 21-28

Abstract: To determine whether glycemic abnormality and pre‐existing diabetes are associated with disease severity and mortality in patients with severe sepsis. Methods Six hundred and nineteen patients with severe sepsis were grouped into four categories according to their blood glucose levels ( 〈 100, 100–199, 200–299, and ≥300 mg/d L ). We compared disease severity and mortality between glycemic categories. In addition, we examined whether there was any relationship with pre‐existing diabetes status. Results There were no significant differences in disseminated intravascular coagulation, S equential O rgan F ailure A ssessment, or A cute P hysiology and C hronic H ealth E valuation II scores and mortality rates between patients with or without pre‐existing diabetes. However, in patients without pre‐existing diabetes, those with blood glucose level 〈 100 mg/d L had higher disseminated intravascular coagulation, S equential O rgan F ailure A ssessment, and A cute P hysiology and C hronic H ealth E valuation II scores than those with levels of 100–299 mg/d L . In addition, those with level ≥300 mg/d L had a higher hospital mortality rate than those with levels of 100–199 mg/d L (odds ratio = 4.837). Multivariate logistic regression analysis revealed that a blood glucose level ≥300 mg/d L is an independent predictor of hospital mortality in these patients. In contrast, no significant differences among severity scores or mortality were observed in patients with pre‐existing diabetes. Conclusions In patients with severe sepsis, the impact of glycemic abnormality on disease severity and hospital mortality depends on the pre‐existing diabetes status. Specifically, a blood glucose level ≥300 mg/d L may be associated with increased mortality in patients without pre‐existing diabetes.

Type of Medium: Online Resource

ISSN: 2052-8817 , 2052-8817

URL: Issue

URL: Article

DOI: 10.1002/ams2.2015.2.issue-1

DOI: 10.1002/ams2.59

Language: English

Publisher: Wiley

Publication Date: 2015

detail.hit.zdb_id: 2751184-4

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Clinical characteristics of patients with severe sepsis and septic shock in relation to bacterial virulence of beta‐hemolytic Streptococcus and Streptococcus pneumoniae

Hifumi, Toru ; Fujishima, Seitaro ; Ubukata, Kimiko ; [et al.]

Wiley ; 2020

In: Acute Medicine & Surgery Vol. 7, No. 1 ( 2020-01)

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In: Acute Medicine & Surgery, Wiley, Vol. 7, No. 1 ( 2020-01)

Abstract: Combined detailed analysis of patient characteristics and treatment as well as bacterial virulence factors, which all play a central role in the cause of infections leading to severe illness, has not been reported. We aimed to describe the patient characteristics (Charlson comorbidity index [CCI]), treatment (3‐h bundle), and outcomes in relation to bacterial virulence of Streptococcus pneumoniae and beta‐hemolytic Streptococcus (BHS). Methods This sepsis primary study is part of the larger Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study, a multicenter, prospective cohort study. We included patients diagnosed with S. pneumoniae and BHS sepsis and examined virulence, defining the high‐virulence factor as follows: S. pneumoniae serotype 3, 31, 11A, 35F, and 17F; Streptococcus pyogenes , emm 1 ; Streptococcus agalactiae , III; and Streptococcus dysgalactiae ssp. equisimilis , emm typing pattern stG 6792 . Included patients were divided into high and normal categories based on the virulence factor. Results Of 1,184 sepsis patients enrolled in the Japanese Association for Acute Medicine’s FORECAST study, 62 were included in the current study (29 cases with S. pneumoniae sepsis and 33 with BHS). The CCI and completion of a 3‐h bundle did not differ between normal and high virulence groups. Risk of 28‐day mortality was significantly higher for high‐virulence compared to normal‐virulence when adjusted for CCI and completion of a 3‐h bundle (Cox proportional hazards regression analysis, hazard ratio 3.848; 95% confidence interval, 1.108–13.370; P = 0.034). Conclusion The risk of 28‐day mortality was significantly higher for patients with high‐virulence compared to normal‐virulence bacteria.

Type of Medium: Online Resource

ISSN: 2052-8817 , 2052-8817

URL: Issue

URL: Article

DOI: 10.1002/ams2.v7.1

DOI: 10.1002/ams2.513

Language: English

Publisher: Wiley

Publication Date: 2020

detail.hit.zdb_id: 2751184-4

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