Significance of body temperature in elderly patients with sepsis

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; Osamu Tasaki; Yasumitsu Mizobata; Hiraku Funakoshi; Toshiro Okuyama; Iwao Yamashita; Toshio Kanai; Yasuo Yamada; Mayuki Aibiki; Keiji Sato; Susumu Yamashita; Kenichi Yoshida; Shunji Kasaoka; Akihide Kon; Hiroshi Rinka; Hiroshi Kato; Hiroshi Okudera; Eichi Narimatsu; Toshifumi Fujiwara; Manabu Sugita; Yasuo Shichinohe; Hajime Nakae; Ryouji Iiduka; Mitsunobu Nakamura; Yuji Murata; Yoshitake Sato; Hiroyasu Ishikura; Yasuhiro Myojo; Yasuyuki Tsujita; Kosaku Kinoshita; Hiroyuki Yamaguchi; Toshihiro Sakurai; Satoru Miyatake; Takao Saotome; Susumu Yasuda; Yasuaki Mizushima

doi:10.1186/s13054-020-02976-6

Significance of body temperature in elderly patients with sepsis

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 SasakiShin Ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Kazuma Yamakawa, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Satoshi Fujimi, Satoshi Gando, Osamu Tasaki, Yasumitsu Mizobata, Hiraku Funakoshi, Toshiro Okuyama, Iwao Yamashita, Toshio Kanai, Yasuo Yamada, Mayuki Aibiki, Keiji Sato, Susumu Yamashita, Kenichi Yoshida, Shunji Kasaoka, Akihide Kon, Hiroshi Rinka, Hiroshi Kato, Hiroshi Okudera, Eichi Narimatsu, Toshifumi Fujiwara, Manabu Sugita, Yasuo Shichinohe, Hajime Nakae, Ryouji Iiduka, Mitsunobu Nakamura, Yuji Murata, Yoshitake Sato, Hiroyasu Ishikura, Yasuhiro Myojo, Yasuyuki Tsujita, Kosaku Kinoshita, Hiroyuki Yamaguchi, Toshihiro Sakurai, Satoru Miyatake, Takao Saotome, Susumu Yasuda, Yasuaki Mizushima

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

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.

Original language	English
Article number	387
Journal	Critical Care
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s13054-020-02976-6
Publication status	Published - 2020 Jun 30

Keywords

Body temperature
Elderly
Fever
Hypothermia
Septic shock

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

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10.1186/s13054-020-02976-6

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Shimazui, T., Nakada, T. A., Walley, K. R., Oshima, T., Abe, T., Ogura, H., Shiraishi, A., Kushimoto, S., Saitoh, D., Fujishima, S., Mayumi, T., Shiino, Y., Tarui, T., Hifumi, T., Otomo, Y., Okamoto, K., Umemura, Y., Kotani, J., Sakamoto, Y., ... Mizushima, Y. (2020). Significance of body temperature in elderly patients with sepsis. Critical Care, 24(1), [387]. https://doi.org/10.1186/s13054-020-02976-6

Shimazui, T, Nakada, TA, Walley, KR, Oshima, T, Abe, T, Ogura, H, Shiraishi, A, Kushimoto, S, Saitoh, D, Fujishima, S, Mayumi, T, Shiino, Y, Tarui, T, Hifumi, T, Otomo, Y, Okamoto, K, Umemura, Y, Kotani, J, Sakamoto, Y, Sasaki, J, Shiraishi, SI, Takuma, K, Tsuruta, R, Hagiwara, A, Yamakawa, K, Masuno, T, Takeyama, N, Yamashita, N, Ikeda, H, Ueyama, M, Fujimi, S, Gando, S, Tasaki, O, Mizobata, Y, Funakoshi, H, Okuyama, T, Yamashita, I, Kanai, T, Yamada, Y, Aibiki, M, Sato, K, Yamashita, S, Yoshida, K, Kasaoka, S, Kon, A, Rinka, H, Kato, H, Okudera, H, Narimatsu, E, Fujiwara, T, Sugita, M, Shichinohe, Y, Nakae, H, Iiduka, R, Nakamura, M, Murata, Y, Sato, Y, Ishikura, H, Myojo, Y, Tsujita, Y, Kinoshita, K, Yamaguchi, H, Sakurai, T, Miyatake, S, Saotome, T, Yasuda, S & Mizushima, Y 2020, 'Significance of body temperature in elderly patients with sepsis', Critical Care, vol. 24, no. 1, 387. https://doi.org/10.1186/s13054-020-02976-6

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title = "Significance of body temperature in elderly patients with sepsis",

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.",

keywords = "Body temperature, Elderly, Fever, Hypothermia, Septic shock",

author = "Takashi Shimazui and Nakada, {Taka Aki} and Walley, {Keith R.} and Taku Oshima and Toshikazu Abe and Hiroshi Ogura and Atsushi Shiraishi and Shigeki Kushimoto and Daizoh Saitoh and Seitaro Fujishima and Toshihiko Mayumi and Yasukazu Shiino and Takehiko Tarui and Toru Hifumi and Yasuhiro Otomo and Kohji Okamoto and Yutaka Umemura and Joji Kotani and Yuichiro Sakamoto and Junichi Sasaki and Shiraishi, {Shin Ichiro} and Kiyotsugu Takuma and Ryosuke Tsuruta and Akiyoshi Hagiwara and Kazuma Yamakawa and Tomohiko Masuno and Naoshi Takeyama and Norio Yamashita and Hiroto Ikeda and Masashi Ueyama and Satoshi Fujimi and Satoshi Gando and Osamu Tasaki and Yasumitsu Mizobata and Hiraku Funakoshi and Toshiro Okuyama and Iwao Yamashita and Toshio Kanai and Yasuo Yamada and Mayuki Aibiki and Keiji Sato and Susumu Yamashita and Kenichi Yoshida and Shunji Kasaoka and Akihide Kon and Hiroshi Rinka and Hiroshi Kato and Hiroshi Okudera and Eichi Narimatsu and Toshifumi Fujiwara and Manabu Sugita and Yasuo Shichinohe and Hajime Nakae and Ryouji Iiduka and Mitsunobu Nakamura and Yuji Murata and Yoshitake Sato and Hiroyasu Ishikura and Yasuhiro Myojo and Yasuyuki Tsujita and Kosaku Kinoshita and Hiroyuki Yamaguchi and Toshihiro Sakurai and Satoru Miyatake and Takao Saotome and Susumu Yasuda and Yasuaki Mizushima",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s).",

year = "2020",

month = jun,

day = "30",

doi = "10.1186/s13054-020-02976-6",

language = "English",

volume = "24",

journal = "Critical Care",

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TY - JOUR

T1 - Significance of body temperature in elderly patients with sepsis

AU - Shimazui, Takashi

AU - Nakada, Taka Aki

AU - Walley, Keith R.

AU - Oshima, Taku

AU - Abe, Toshikazu

AU - Ogura, Hiroshi

AU - Shiraishi, Atsushi

AU - Kushimoto, Shigeki

AU - Saitoh, Daizoh

AU - Fujishima, Seitaro

AU - Mayumi, Toshihiko

AU - Shiino, Yasukazu

AU - Tarui, Takehiko

AU - Hifumi, Toru

AU - Otomo, Yasuhiro

AU - Okamoto, Kohji

AU - Umemura, Yutaka

AU - Kotani, Joji

AU - Sakamoto, Yuichiro

AU - Sasaki, Junichi

AU - Shiraishi, Shin Ichiro

AU - Takuma, Kiyotsugu

AU - Tsuruta, Ryosuke

AU - Hagiwara, Akiyoshi

AU - Yamakawa, Kazuma

AU - Masuno, Tomohiko

AU - Takeyama, Naoshi

AU - Yamashita, Norio

AU - Ikeda, Hiroto

AU - Ueyama, Masashi

AU - Fujimi, Satoshi

AU - Gando, Satoshi

AU - Tasaki, Osamu

AU - Mizobata, Yasumitsu

AU - Funakoshi, Hiraku

AU - Okuyama, Toshiro

AU - Yamashita, Iwao

AU - Kanai, Toshio

AU - Yamada, Yasuo

AU - Aibiki, Mayuki

AU - Sato, Keiji

AU - Yamashita, Susumu

AU - Yoshida, Kenichi

AU - Kasaoka, Shunji

AU - Kon, Akihide

AU - Rinka, Hiroshi

AU - Kato, Hiroshi

AU - Okudera, Hiroshi

AU - Narimatsu, Eichi

AU - Fujiwara, Toshifumi

AU - Sugita, Manabu

AU - Shichinohe, Yasuo

AU - Nakae, Hajime

AU - Iiduka, Ryouji

AU - Nakamura, Mitsunobu

AU - Murata, Yuji

AU - Sato, Yoshitake

AU - Ishikura, Hiroyasu

AU - Myojo, Yasuhiro

AU - Tsujita, Yasuyuki

AU - Kinoshita, Kosaku

AU - Yamaguchi, Hiroyuki

AU - Sakurai, Toshihiro

AU - Miyatake, Satoru

AU - Saotome, Takao

AU - Yasuda, Susumu

AU - Mizushima, Yasuaki

PY - 2020/6/30

Y1 - 2020/6/30

N2 - 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.

AB - 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.

KW - Body temperature

KW - Elderly

KW - Fever

KW - Hypothermia

KW - Septic shock

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JF - Critical Care

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ER -

Significance of body temperature in elderly patients with sepsis

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