title: The presence of hypothermia within 24 hours of sepsis diagnosis predicts persistent lymphopenia.
abstract: OBJECTIVE
  To determine whether hypothermia within 24 hours of sepsis diagnosis is associated with development of persistent lymphopenia, a feature of sepsis-induced immunosuppression.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A 1,200-bed university-affiliated tertiary care hospital.
  
  
  METHODS
  Adult patients diagnosed with bacteremia and sepsis within 5 days of hospital admission between January 1, 2010, and July 31, 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Leukocyte counts were recorded during the first 4 days following sepsis diagnosis. Persistent lymphopenia was defined as an absolute lymphocyte count less than 1.2 cells/μL×10(3) present on the fourth day after diagnosis. Of the 445 patients with sepsis included, hypothermia developed in 64 patients (14.4%) (defined as a body temperature<36.0°C) within 24 hours of sepsis diagnosis. Hypothermia was a significant independent predictor of persistent lymphopenia (adjusted odds ratio, 2.70 [95% CI, 1.10, 6.60]; p=0.03) after accounting for age, disease severity, comorbidities, source of bacteremia, and type of organism. Compared with the nonhypothermic patients, hypothermic patients had higher 28-day (50.0% vs 24.9%, p<0.001) and 1-year mortality (60.9% vs 47.0%, p=0.001).
  
  
  CONCLUSIONS
  Hypothermia is associated with higher mortality and an increased risk of persistent lymphopenia in patients with sepsis, and it may be an early clinical predictor of sepsis-induced immunosuppression.
authors: 1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. 2Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO. 3Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO. 4Department of Surgery, Washington University School of Medicine, St. Louis, MO.
authors: Anne M
authors: AM
authors: Drewry
authors: Brian M
authors: BM
authors: Fuller
authors: Lee P
authors: LP
authors: Skrupky
authors: Richard S
authors: RS
authors: Hotchkiss
mesh_terms: D018806:APACHE; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007035:Hypothermia / Q000097:blood / Q000209:etiology*; D007958:Leukocyte Count; D008231:Lymphopenia / Q000209:etiology*; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications* / Q000401:mortality*