title: Chills in 'early sepsis': good for you?
abstract: We evaluated the predictive value of chills, bacteraemia and endotoxaemia for in-hospital mortality and survival at 5-10 years long-term follow-up in a prospective cohort of 'early sepsis' patients presenting with fever resulting from community-acquired pneumonia or pyelonephritis. Febrile patients with chills had bacteraemia more often (RR 3.1, 95% CI 1.8-5.4) than those without chills. Neither chills nor bacteraemia were significantly related to in-hospital mortality, but patients with endotoxaemia had a higher in-hospital mortality rate than those without endotoxaemia. Patients with chills had a significantly higher survival rate at long-term follow-up than those without chills on admission: the estimated risk of dying was 0.644 (95% CI 0.43-0.95, P = 0.029) for an individual with chills, compared to a person without chills, adjusting for the other factors [age cohort, underlying disease and the pro-inflammatory response in the blood, i.e. tumour necrosis factor-alpha (TNF-alpha) and blood leucocyte number, as scored on hospital admission] in the Cox proportional hazards model. Chills may characterize a patient subpopulation that upon pulmonary and urinary tract infection is able to raise a more rapid and/or efficient host response.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands. j.t.van_dissel@lumc.nl
authors.forename: J T
authors.initials: JT
authors.lastname: Van Dissel
authors.forename: S C
authors.initials: SC
authors.lastname: Numan
authors.forename: J W
authors.initials: JW
authors.lastname: Van't Wout
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000276:immunology / Q000401:mortality; D023341:Chills / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D019446:Endotoxemia / Q000150:complications* / Q000276:immunology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D018805:Sepsis / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D014409:Tumor Necrosis Factor-alpha