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Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU*

Sundén-Cullberg, Jonas MD, PhD1; Rylance, Rebecca MSc2; Svefors, Jesper MD3; Norrby-Teglund, Anna PhD1; Björk, Jonas PhD4; Inghammar, Malin MD, PhD5

doi: 10.1097/CCM.0000000000002249
Clinical Investigations

Objectives: To study the prognostic value of fever in the emergency department in septic patients subsequently admitted to the ICU.

Design: Observational cohort study from the Swedish national quality register for sepsis.

Setting: Thirty ICU’s in Sweden.

Patients: Two thousand two hundred twenty-five adults who were admitted to an ICU within 24 hours of hospital arrival with a diagnosis of severe sepsis or septic shock were included.

Interventions: None.

Measurements and Main Results: Body temperature was measured and classified according to four categories (< 37°C, 37–38.29°C, 38.3–39.5°C, ≥ 39.5°C). The main outcome was in-hospital mortality. Odds ratios for mortality according to body temperature were estimated using multivariable logistic regression. Subgroup analyses were conducted according to age, sex, underlying comorbidity, and time to given antibiotics. Overall mortality was 25%. More than half of patients had a body temperature below 38.3°C. Mortality was inversely correlated with temperature and decreased, on average, more than 5% points per °C increase, from 50% in those with the lowest temperatures to 9% in those with the highest. Increased body temperature in survivors was also associated with shorter hospital stays. Patients with fever received better quality of care, but the inverse association between body temperature and mortality was robust and remained consistent after adjustment for quality of care measures and other factors that could have confounded the association. Among vital signs, body temperature was best at predicting mortality.

Conclusions: Contrary to common perceptions and current guidelines for care of critically ill septic patients, increased body temperature in the emergency department was strongly associated with lower mortality and shorter hospital stays in patients with severe sepsis or septic shock subsequently admitted to the ICU.

1Division of Infectious Diseases and Center for Infectious Medicine, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Sweden.

2National Registry Centre, Skåne University Hospital Lund, Skåne, Sweden.

3Department of Infectious Diseases, Ryhov Hospital, Jönköping, Sweden.

4Division of occupational and environmental medicine, Lund University, Lund, Sweden.

5Department of Clinical Sciences, Section for Infection Medicine, Lund University, Skåne University Hospital, Lund, Sweden.

*See also p. 747.

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The Swedish national quality register for severe sepsis and septic shock was originally funded by the Swedish Infectious disease society; current funding is from the Swedish Association of Local Authorities and Regions. This study was supported by grants from Swedish Government Research Grant (ALF) and the Royal Physiographic Society in Lund. The funders played no role in the design of the study, data collection or analysis, decision to publish, or preparation of the article.

Dr. Rylance’s institution received funding from Department of Infectious Diseases Skane University Hospital, Lund, and she disclosed work for hire. Dr. Inghammar received funding from Swedish Government Research Grant (ALF) and the Royal Physiographic Society in Lund. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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