Exploring temperature trajectories in emergency department sepsis patients.

INTRODUCTION

Sepsis presents a global challenge to emergency departments (ED) due to its varied presentation and life-threatening outcomes. The quick Sequential Organ Failure Assessment score's introduction expanded sepsis diagnostics beyond the traditional Systemic Inflammatory Response Syndrome, which considered body temperature. However, body temperature remains a vital clinical marker. This study analyzes body temperature patterns in ED sepsis patients and their impact on treatment and outcomes.

METHODS

This retrospective cohort study analyzed the data from the MIMIC-IV database, focusing on sepsis patients diagnosed within 12 h of ED triage. Patients were split into derivation (n = 3872) and replication (n = 1660) cohorts in a 7:3 ratio and categorized into body temperature trajectory subgroups using group-based trajectory modeling. The model's effectiveness was assessed using the Bayesian Information Criterion, with validation in a replication cohort. Analysis of variance and chi-squared tests were used to evaluate patient characteristics and outcomes.

RESULTS

Four distinct body temperature patterns were identified: Hypothermic (0.9 %), Normothermic (74.1 %), Progressive Fever (10.7 %), and Fever Resolver (14.4 %). The Hypothermic group had the highest mortality rate (37.5 %), while the Normothermic, Progressive Fever, and Fever Resolver groups had mortality rates of 11.7 %, 9.14 %, and 9.78 %, respectively (p < 0.001).

CONCLUSIONS

Fever is not always a reliable sepsis indicator; many patients present normothermic or hypothermic, notably the highest mortality cohort. Including diverse temperature patterns in sepsis assessments could enhance patient outcomes.