Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Septicemia | Research

Significance of body temperature in elderly patients with sepsis

Authors: Takashi Shimazui, Taka-aki Nakada, Keith R. Walley, Taku Oshima, Toshikazu Abe, Hiroshi Ogura, Atsushi Shiraishi, Shigeki Kushimoto, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Yasukazu Shiino, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Yutaka Umemura, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin-ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Kazuma Yamakawa, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Satoshi Gando, on behalf of the JAAM FORECAST Group

Published in: Critical Care | Issue 1/2020

Login to get access

Abstract

Background

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.
Appendix
Available only for authorised users
Literature
1.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.CrossRef
2.
Nishida O, Ogura H, Egi M, Fujishima S, Hayashi Y, Iba T, et al. The Japanese clinical practice guidelines for management of sepsis and septic shock 2016 (J-SSCG 2016). Acute Med Surg. 2018;5:3–89.CrossRef
3.
Wiersinga WJ, Leopold SJ, Cranendonk DR, van der Poll T. Host innate immune responses to sepsis. Virulence. 2014;5:36–44.CrossRef
4.
Deutschman CS, Raj NR, McGuire EO, Kelz MB. Orexinergic activity modulates altered vital signs and pituitary hormone secretion in experimental sepsis. Crit Care Med. 2013;41:e368–75.CrossRef
5.
Yamamoto S, Yamazaki S, Shimizu T, Takeshima T, Fukuma S, Yamamoto Y, et al. Body temperature at the emergency department as a predictor of mortality in patients with bacterial infection. Medicine (Baltimore). 2016;95:e3628.CrossRef
6.
Peres Bota D, Lopes Ferreira F, Melot C, Vincent JL. Body temperature alterations in the critically ill. Intensive Care Med. 2004;30:811–6.CrossRef
7.
Hayase N, Yamamoto M, Asada T, Isshiki R, Yahagi N, Doi K. Association of heart rate with N-terminal pro-B-type natriuretic peptide in septic patients: a prospective observational cohort study. Shock. 2016;46:642–8.CrossRef
8.
Houwink AP, Rijkenberg S, Bosman RJ, van der Voort PH. The association between lactate, mean arterial pressure, central venous oxygen saturation and peripheral temperature and mortality in severe sepsis: a retrospective cohort analysis. Crit Care. 2016;20:56.CrossRef
9.
Tang Y, Choi J, Kim D, Tudtud-Hans L, Li J, Michel A, et al. Clinical predictors of adverse outcome in severe sepsis patients with lactate 2-4 mM admitted to the hospital. QJM. 2015;108:279–87.CrossRef
10.
Sansoni P, Vescovini R, Fagnoni F, Biasini C, Zanni F, Zanlari L, et al. The immune system in extreme longevity. Exp Gerontol. 2008;43:61–5.CrossRef
11.
Linton PJ, Dorshkind K. Age-related changes in lymphocyte development and function. Nat Immunol. 2004;5:133–9.CrossRef
12.
Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011;12:337–43.CrossRef
13.
Tiruvoipati R, Ong K, Gangopadhyay H, Arora S, Carney I, Botha J. Hypothermia predicts mortality in critically ill elderly patients with sepsis. BMC Geriatr. 2010;10:70.CrossRef
14.
Heffernan DS, Thakkar RK, Monaghan SF, Ravindran R, Adams CA Jr, Kozloff MS, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma. 2010;69:813–20.CrossRef
15.
Churpek MM, Yuen TC, Winslow C, Hall J, Edelson DP. Differences in vital signs between elderly and nonelderly patients prior to ward cardiac arrest. Crit Care Med. 2015;43:816–22.CrossRef
16.
Abe T, Ogura H, Shiraishi A, Kushimoto S, Saitoh D, Fujishima S, et al. Characteristics, management, and in-hospital mortality among patients with severe sepsis in intensive care units in Japan: the FORECAST study. Crit Care. 2018;22:322.CrossRef
17.
Ogura H, Gando S, Saitoh D, Takeyama N, Kushimoto S, Fujishima S, et al. Epidemiology of severe sepsis in Japanese intensive care units: a prospective multicenter study. J Infect Chemother. 2014;20:157–62.CrossRef
18.
Nakada TA, Russell JA, Boyd JH, Aguirre-Hernandez R, Thain KR, Thair SA, et al. beta2-Adrenergic receptor gene polymorphism is associated with mortality in septic shock. Am J Respir Crit Care Med. 2010;181:143–9.CrossRef
19.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med. 2003;29:530–8.CrossRef
20.
Ouchi Y, Rakugi H, Arai H, Akishita M, Ito H, Toba K, et al. Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int. 2017;17:1045–7.CrossRef
21.
Guidet B, Leblanc G, Simon T, Woimant M, Quenot JP, Ganansia O, et al. Effect of systematic intensive care unit triage on long-term mortality among critically ill elderly patients in France: a randomized clinical trial. JAMA. 2017;318:1450–9.CrossRef
22.
Chou HL, Han ST, Yeh CF, Tzeng IS, Hsieh TH, Wu CC, et al. Systemic inflammatory response syndrome is more associated with bacteremia in elderly patients with suspected sepsis in emergency departments. Medicine (Baltimore). 2016;95:e5634.CrossRef
23.
Nakada TA, Wacharasint P, Russell JA, Boyd JH, Nakada E, Thair SA, et al. The IL20 genetic polymorphism is associated with altered clinical outcome in septic shock. J Innate Immun. 2018;10:181–8.CrossRef
24.
Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34:15–21.CrossRef
25.
Blot S, Cankurtaran M, Petrovic M, Vandijck D, Lizy C, Decruyenaere J, et al. Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients. Crit Care Med. 2009;37:1634–41.CrossRef
26.
Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care. 2019;9:26.CrossRef
27.
Flaatten H, De Lange DW, Morandi A, Andersen FH, Artigas A, Bertolini G, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43:1820–8.CrossRef
28.
Warmerdam M, Stolwijk F, Boogert A, Sharma M, Tetteroo L, Lucke J, et al. Initial disease severity and quality of care of emergency department sepsis patients who are older or younger than 70 years of age. PLoS One. 2017;12:e0185214.CrossRef
29.
Schieber AM, Ayres JS. Thermoregulation as a disease tolerance defense strategy. Pathog Dis. 2016;74:ftw106.
30.
Evans SS, Repasky EA, Fisher DT. Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol. 2015;15:335–49.CrossRef
31.
Garami A, Steiner AA, Romanovsky AA. Fever and hypothermia in systemic inflammation. Handb Clin Neurol. 2018;157:565–97.CrossRef
32.
Kushimoto S, Abe T, Ogura H, Shiraishi A, Saitoh D, Fujishima S, et al. 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. Crit Care Med. 2019;47:691–9.CrossRef
33.
Kushimoto S, Gando S, Saitoh D, Mayumi T, Ogura H, Fujishima S, et al. 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. Crit Care. 2013;17:R271.CrossRef
34.
Drewry AM, Fuller BM, Skrupky LP, Hotchkiss RS. The presence of hypothermia within 24 hours of sepsis diagnosis predicts persistent lymphopenia. Crit Care Med. 2015;43:1165–9.CrossRef
35.
Sunden-Cullberg J, Rylance R, Svefors J, Norrby-Teglund A, Bjork J, Inghammar M. Fever in the emergency department predicts survival of patients with severe sepsis and septic shock admitted to the ICU. Crit Care Med. 2017;45:591–9.CrossRef
36.
Mackowiak PA, Bartlett JG, Borden EC, Goldblum SE, Hasday JD, Munford RS, et al. Concepts of fever: recent advances and lingering dogma. Clin Infect Dis. 1997;25:119–38.CrossRef
37.
38.
Morrison SF. Central control of body temperature. F1000Res. 2016;5:F1000 Faculty Rev-880.
39.
Cheshire WP Jr. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci. 2016;196:91–104.CrossRef
40.
Kenney WL, Munce TA. Invited review: aging and human temperature regulation. J Appl Physiol (1985). 2003;95:2598–603.CrossRef
41.
Waalen J, Buxbaum JN. Is older colder or colder older? The association of age with body temperature in 18,630 individuals. J Gerontol A Biol Sci Med Sci. 2011;66:487–92.CrossRef
42.
Gomolin IH, Aung MM, Wolf-Klein G, Auerbach C. Older is colder: temperature range and variation in older people. J Am Geriatr Soc. 2005;53:2170–2.CrossRef
Metadata
Title
Significance of body temperature in elderly patients with sepsis
Authors
Takashi Shimazui
Taka-aki Nakada
Keith R. Walley
Taku Oshima
Toshikazu Abe
Hiroshi Ogura
Atsushi Shiraishi
Shigeki Kushimoto
Daizoh Saitoh
Seitaro Fujishima
Toshihiko Mayumi
Yasukazu Shiino
Takehiko Tarui
Toru Hifumi
Yasuhiro Otomo
Kohji Okamoto
Yutaka Umemura
Joji Kotani
Yuichiro Sakamoto
Junichi Sasaki
Shin-ichiro Shiraishi
Kiyotsugu Takuma
Ryosuke Tsuruta
Akiyoshi Hagiwara
Kazuma Yamakawa
Tomohiko Masuno
Naoshi Takeyama
Norio Yamashita
Hiroto Ikeda
Masashi Ueyama
Satoshi Fujimi
Satoshi Gando
on behalf of the JAAM FORECAST Group
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-02976-6

Other articles of this Issue 1/2020

Critical Care 1/2020 Go to the issue

Research

Nasal high flow higher than 60 L/min in patients with acute hypoxemic respiratory failure: a physiological study

Research

Lactate kinetics in ICU patients using a bolus of 13C-labeled lactate

Letter

Do critically ill patients with AKI benefit from furosemide? Further real-word evidence from a large multi-center database

Research

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

Research Letter

Three-step checklist for tracheostomy in critically ill COVID-19 patients

Research

Antibiotic-related gut dysbiosis induces lung immunodepression and worsens lung infection in mice