title: Hospitalized acute patients with fever and severe infection have lower mortality than patients with hypo- or normothermia: a follow-up study.
abstract: OBJECTIVE
  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 (<36.0ºC), normothermia (36.0ºC-38.0ºC) and fever (>38.0ºC). Severe infection was defined as a discharge diagnosis indicating infection combined with organ failure within the first 24 h 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-term mortality, whereas patients with fever were associated with a lower risk compared to those with normothermia.
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: D P
authors.initials: DP
authors.lastname: Henriksen
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Havshøj
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: P B
authors.initials: PB
authors.lastname: Pedersen
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: C B
authors.initials: CB
authors.lastname: Laursen
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: H K
authors.initials: HK
authors.lastname: Jensen
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Brabrand
authors.affiliation: Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark.
authors.forename: A T
authors.initials: AT
authors.lastname: Lassen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001831:Body Temperature; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000401:mortality* / Q000503:physiopathology; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007035:Hypothermia / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000401:mortality* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents