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Body Temperature at the Emergency Department as a Predictor of Mortality in Patients With Bacterial Infection

Yamamoto, Shungo MD, DTM&H, DrPH; Yamazaki, Shin PhD; Shimizu, Tsunehiro MD, PhD; Takeshima, Taro MD, PhD; Fukuma, Shingo MD, PhD; Yamamoto, Yosuke MD, PhD; Tochitani, Kentaro MD; Tsuchido, Yasuhiro MD; Shinohara, Koh MD; Fukuhara, Shunichi MD, DMSc

Section Editor(s): Asensi., Victor

doi: 10.1097/MD.0000000000003628
Research Article: Observational Study

Abstract: Hypothermia is a risk factor for death in intensive care unit (ICU) patients with severe sepsis and septic shock. In the present study, we investigated the association between body temperature (BT) on arrival at the emergency department (ED) and mortality in patients with bacterial infection.

We conducted a retrospective cohort study in consecutive ED patients over 15 years of age with bacterial infection who were admitted to an urban teaching hospital in Japan between 2010 and 2012. The main outcome measure was 30-day in-hospital mortality. Each patient was assigned to 1 of 6 categories based on BT at ED admission. We conducted multivariable logistic regression analysis to adjust for predictors of death.

A total of 913 patients were enrolled in the study. The BT categories were <36, 36 to 36.9, 37 to 37.9, 38 to 38.9, 39 to 39.9, and ≥40 °C, with respective mortalities of 32.5%, 14.1%, 8.7%, 8.2%, 5.7%, and 5.3%. Multivariable analysis showed that the risk of death was significantly low in patients with BT 37 to 37.9 °C (adjusted odds ratio [AOR]: 0.2; 95% confidence interval [CI] 0.1–0.6, P = 0.003), 38–38.9 °C (AOR: 0.2; 95% CI 0.1–0.6, P = 0.002), 39–39.9 °C (AOR: 0.2; 95% CI 0.1–0.5, P = 0.001), and ≥40 °C (AOR: 0.1; 95% CI 0.02–0.4, P = 0.001), compared with hypothermic patients (BT <36 °C).

The higher BT on arrival at ED, the better the outcomes observed in patients with bacterial infection were.

From the Department of Healthcare Epidemiology (SY, SY, TT, SF, YY, SF), School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto; Division of Infectious Diseases (SY), Kobe University Hospital, Hyogo; Current affiliation: Center for Environmental Health Sciences (SY), National Institute for Environmental Studies, Ibaraki; Department of Infectious Diseases (TS, KT, YT, KS), Kyoto City Hospital, Kyoto; Division of Community and Family Medicine (TT), Center for Community Medicine, Jichi Medical University, Tochigi; Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE) (SF, SF), Fukushima Medical University, Fukushima; Department of Clinical Laboratory Medicine (current affiliation for YT), Graduate School of Medicine, Kyoto University, Kyoto; and Disease Control and Prevenion Center (current affiliation for KS), National Center for Global Health and Medicine, Tokyo, Japan.

Correspondence: Shunichi Fukuhara, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoemachi, Sakyo-ku, Kyoto 606 8501, Japan (e-mail:

Abbreviations: AOR = adjusted odds ratio, BT = body temperature, CI = confidence interval, ED = emergency department, RR = respiratory rate.

Presented in Part: 25th European Congress of Clinical Microbiology and Infectious Diseases. April 25 to 28, 2015, Copenhagen, Denmark.

SY had full access to all data in the study, takes responsibility for the integrity of the data and accuracy of the data analysis, and wrote the 1st draft; TS, KT, YT, and KS collected and interpreted the data and drafted the paper; and SY, TT, SF, YY, and SF supervised the research, interpreted the data, and helped draft the manuscript.

The authors have no funding and conflicts of interests to disclose.

This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially.

Received December 7, 2015

Received in revised form March 29, 2016

Accepted April 13, 2016

Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.