title: Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients: a case-control study.
abstract: BACKGROUND
  Early treatment of sepsis improves survival, but early diagnosis of hospital-acquired sepsis, especially in critically ill patients, is challenging. Evidence suggests that subtle changes in body temperature patterns may be an early indicator of sepsis, but data is limited. The aim of this study was to examine whether abnormal body temperature patterns, as identified by visual examination, could predict the subsequent diagnosis of sepsis in afebrile critically ill patients.
  
  
  METHODS
  Retrospective case-control study of 32 septic and 29 non-septic patients in an adult medical and surgical ICU. Temperature curves for the period starting 72 hours and ending 8 hours prior to the clinical suspicion of sepsis (for septic patients) and for the 72-hour period prior to discharge from the ICU (for non-septic patients) were rated as normal or abnormal by seven blinded physicians. Multivariable logistic regression was used to compare groups in regard to maximum temperature, minimum temperature, greatest change in temperature in any 24-hour period, and whether the majority of evaluators rated the curve to be abnormal.
  
  
  RESULTS
  Baseline characteristics of the groups were similar except the septic group had more trauma patients (31.3% vs. 6.9%, p = .02) and more patients requiring mechanical ventilation (75.0% vs. 41.4%, p = .008). Multivariable logistic regression to control for baseline differences demonstrated that septic patients had significantly larger temperature deviations in any 24-hour period compared to control patients (1.5°C vs. 1.1°C, p = .02). An abnormal temperature pattern was noted by a majority of the evaluators in 22 (68.8%) septic patients and 7 (24.1%) control patients (adjusted OR 4.43, p = .017). This resulted in a sensitivity of 0.69 (95% CI [confidence interval] 0.50, 0.83) and specificity of 0.76 (95% CI 0.56, 0.89) of abnormal temperature curves to predict sepsis. The median time from the temperature plot to the first culture was 9.40 hours (IQR [inter-quartile range] 8.00, 18.20) and to the first dose of antibiotics was 16.90 hours (IQR 8.35, 34.20).
  
  
  CONCLUSIONS
  Abnormal body temperature curves were predictive of the diagnosis of sepsis in afebrile critically ill patients. Analysis of temperature patterns, rather than absolute values, may facilitate decreased time to antimicrobial therapy.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Drewry
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bailey
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hotchkiss
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature / Q000502:physiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*
references.citation: N Engl J Med. 2001 Nov 8;345(19):1368-77
references.pmid: 11794169
references.citation: Crit Care Med. 2001 Jul;29(7):1303-10
references.pmid: 11445675
references.citation: Shock. 2011 Sep;36(3):318-20; discussion 320-1
references.pmid: 21844790
references.citation: Intensive Care Med. 2008 May;34(5):856-64
references.pmid: 18259728
references.citation: Ann Intern Med. 2007 Oct 16;147(8):573-7
references.pmid: 17938396
references.citation: Intensive Care Med. 1999 Jul;25(7):668-73
references.pmid: 10470569
references.citation: Intensive Care Med. 2004 May;30(5):811-6
references.pmid: 15127194
references.citation: Crit Care Med. 2005 Oct;33(10):2184-93
references.pmid: 16215368
references.citation: Curr Infect Dis Rep. 2012 Oct;14(5):512-21
references.pmid: 22864954
references.citation: Crit Care Med. 2006 Nov;34(11):2707-13
references.pmid: 16943733
references.citation: Crit Care Med. 1992 Oct;20(10):1395-401
references.pmid: 1395659
references.citation: Clin Vaccine Immunol. 2008 Jul;15(7):1089-94
references.pmid: 18480235
references.citation: Am J Med. 1996 Jan;100(1):65-70
references.pmid: 8579089
references.citation: J Crit Care. 2012 Oct;27(5):428-33
references.pmid: 22227089
references.citation: JAMA. 1982 Sep 24;248(12):1478-81
references.pmid: 7109169
references.citation: Pediatr Res. 2003 Jun;53(6):920-6
references.pmid: 12646726
references.citation: N Engl J Med. 2003 Jan 9;348(2):138-50
references.pmid: 12519925
references.citation: PLoS One. 2012;7(9):e45666
references.pmid: 23029171
references.citation: J Pediatr. 2011 Dec;159(6):900-6.e1
references.pmid: 21864846
references.citation: J Emerg Med. 2012 Mar;42(3):254-9
references.pmid: 20674238
references.citation: Intensive Care Med. 2002 Feb;28(2):108-21
references.pmid: 11907653
references.citation: Intensive Care Med. 2003 Apr;29(4):530-8
references.pmid: 12664219
references.citation: Am J Respir Crit Care Med. 2001 Feb;163(2):316-21
references.pmid: 11179099
references.citation: Crit Care. 2005;9(6):R764-70
references.pmid: 16356225
references.citation: Arch Intern Med. 1998 Sep 28;158(17):1870-81
references.pmid: 9759682
references.citation: Crit Care Med. 2013 Feb;41(2):580-637
references.pmid: 23353941
references.citation: Crit Care. 2012 Dec 12;16(2):R51
references.pmid: 22424316
references.citation: Crit Care Med. 2007 Apr;35(4):1105-12
references.pmid: 17334251
references.citation: Am J Respir Crit Care Med. 2006 Aug 1;174(3):290-8
references.pmid: 16690981
references.citation: Crit Care Med. 2008 Apr;36(4):1330-49
references.pmid: 18379262
references.citation: Crit Care Med. 2010 Feb;38(2):367-74
references.pmid: 20035219
references.citation: Crit Care Med. 2006 Jun;34(6):1589-96
references.pmid: 16625125
references.citation: Crit Care. 2010;14(5):R192
references.pmid: 21034463
references.citation: JAMA. 2011 Dec 21;306(23):2594-605
references.pmid: 22187279
references.citation: Med Biol Eng Comput. 2007 Jul;45(7):671-8
references.pmid: 17549533
references.citation: JAMA. 1992 Sep 23-30;268(12):1578-80
references.pmid: 1302471
references.citation: Crit Care Med. 2008 May;36(5):1531-5
references.pmid: 18434882