Hospitalized acute patients with fever and severe infection have lower mortality than patients with hypo- or normothermia: A follow-up study

Abstract

Objectives: Severe infection is a frequent cause of admission to an acute medical unit (AMU). However, not all infected patients present with fever. The aim was to assess differences in 30-day mortality among patients hospitalized with community- acquired severe infection presenting with hypothermia, normothermia or fever. Methods: A retrospective single-center follow-up at an AMU from August 1, 2009 to August 31, 2011. Patients were included the first time they presented with severe infection within the study period. Temperature was categorized into hypothermia (<36.0°C), normothermia (36.0°C-38.0°C) and fever (>38.0°C). Severe infection was defined as a discharge diagnosis indicating infection combined with organ failure within the first 24h after arrival. Multivariable Cox regression analysis was computed to assess the association between temperature and 30-day mortality. Results: A total of 2128 patients with severe infection were included. 3.0% (N = 64) were hypothermic, 57.1% (N = 1216) normothermic and 39.9% (N = 848) had fever at arrival. Crude 30-day mortality was 16.1% (N = 342, 95%CI 14.5-17.7%); 37.5% (N = 24, 95% CI 25.7-50.5%) for hypothermic patients, 18.3% (N = 223, 95%CI 16.2-20.6%) for normothermic patients and 11.2% (N=95, 95%CI 9.2-13.5%) for patients with fever. Compared to normothermic patients, the adjusted hazard ratio of 30- day mortality among hypothermic patients was 1.62 (95%CI 1.06-2.49) and 0.74 (95%CI 0.58-0.94) among patients with fever. Conclusions: Over half of the patients admitted to an AMU with severe infection were normothermic at arrival. Hypothermia was associated with an increased risk of short-termmortality, whereas patients with fever were associated with a lower risk compared to those with normothermia.