Normothermia in Patients With Sepsis Who Present to Emergency Departments Is Associated With Low Compliance With Sepsis Bundles and Increased In-Hospital Mortality Rate*
- Authors
- Park, Sunghoon; Jeon, Kyeongman; Oh, Dong Kyu; Choi, Eun Young; Seong, Gil Myeong; Heo, Jeongwon; Chang, Youjin; Kwack, Won Gun; Kang, Byung Ju; Choi, Wonil; Kim, Kyung Chan; Park, So Young; Shin, Yoon Mi; Lee,Heung Bum; Park, So Hee; Kim, Seok Chan; Kwak, Sang Hyun; Cho, Jae Hwa; Kim, Beongki; Lim, Chae-Man
- Issue Date
- Oct-2020
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- emergency department; mortality; normothermia; sepsis bundles
- Citation
- CRITICAL CARE MEDICINE, v.48, no.10, pp.1462 - 1470
- Indexed
- SCIE
SCOPUS
- Journal Title
- CRITICAL CARE MEDICINE
- Volume
- 48
- Number
- 10
- Start Page
- 1462
- End Page
- 1470
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/190459
- DOI
- 10.1097/CCM.0000000000004493
- ISSN
- 0090-3493
- 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 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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