title: Relative tachycardia in patients with sepsis: an independent risk factor for mortality.
abstract: BACKGROUND
  Excess activation of the sympathetic nervous system may be a risk factor for mortality in patients with the systemic inflammatory response syndrome (SIRS) or sepsis.
  
  
  OBJECTIVE
  To examine whether excessive tachycardia, relative to the degree of fever is an independent risk factor for death in patients with SIRS.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Departments of medicine in three university hospitals in Israel, Germany and Italy.
  
  
  METHODS
  We collected data for 3382 patients with SIRS, whether community- or hospital-acquired, 91% with sepsis, as part of an ongoing trial.
  
  
  RESULTS
  Overall 30-day mortality was 12% (408/3382). The pulse/temperature ratio was significantly higher in patients who died than in survivors: mean +/- SD 2.55 +/- 0.57 vs. 2.40 +/- 0.48 bpm/ degrees C (p < 0.0001). Excessive tachycardia was significantly associated with a mortality in a logistic model accounting for other strong predictors of mortality (OR 1.54, 95%CI 1.10-2.17). Patients with septic shock were the only group for whom this association did not hold.
  
  
  CONCLUSIONS
  Our data are compatible with the hypothesis that some patients with sepsis experience an excess activation of the sympathetic nervous system, leading to a fatal outcome.
authors.affiliation: Department of Medicine E, Rabin Medical Center, Beilinson Campus, and Sackler Faculty of Medicine, Petah-Tiqva 49100, Tel-Aviv University, Israel. leibovic@post.tau.ac.il
authors.forename: L
authors.initials: L
authors.lastname: Leibovici
authors.forename: A
authors.initials: A
authors.lastname: Gafter-Gvili
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.forename: N
authors.initials: N
authors.lastname: Almanasreh
authors.forename: E
authors.initials: E
authors.lastname: Tacconelli
authors.forename: S
authors.initials: S
authors.lastname: Andreassen
authors.forename: A D
authors.initials: AD
authors.lastname: Nielsen
authors.forename: U
authors.initials: U
authors.lastname: Frank
authors.forename: R
authors.initials: R
authors.lastname: Cauda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018746:Systemic Inflammatory Response Syndrome / Q000401:mortality*; D013610:Tachycardia / Q000401:mortality*