The Optimal Oral Body Temperature Cutoff and Other Factors Predictive of Sepsis Diagnosis in Elderly Patients

Overview

Journal Ann Thorac Med

Specialty Pulmonary Medicine

Date 2022 Aug 15

PMID 35968398

Authors

Majid Alsalamah

Bashaer Alrehaili

Amal Almoamary

Abdulrahman Al-Juad

Mutasim Badri

Ashraf El-Metwally

Affiliations

Soon will be listed here.

Abstract

Introduction: The aim of this study was to identify the optimal oral temperature cut-off value and other factors predictive of sepsis in elderly patients presenting to emergency department.

Methods: A hospital-based retrospective study was performed on all elderly patients who presented to the Adult Emergency Department at King Abdulaziz Medical City in Riyadh (January to December 31, 2018).

Results: Of total of 13,856 patients, 2170 (15.7%) were diagnosed with sepsis. The associated area under the curve estimate was 0.73, 95% confidence interval (CI) 0.72-0.74. Body temperature ≥37.3 was found as optimal cut-point with sensitivity = 50.97% and specificity = 87.22% and 82.39% of patients with sepsis will be correctly classified using this cut-off. An increase of 1° in body temperature was associated with an odds ratio of 9.95 (95% CI 8.95-11.06, < 0.0001). Those aged ≥100 years having 11.12 (95% CI 2.29-20.88, < 0.0001) times the likelihood for sepsis diagnosis compared with those aged 60-69 years. People admitted in weather such as winter, spring, or autumn were more likely to develop sepsis than people admitted in summer.

Conclusion: The risk factors of sepsis such as age, temperature, and seasonal variation inform important evidence-based decisions. The hospitals dealing with sepsis patients should assess older patients for other severe illnesses or co-morbid that might lead to sepsis if left untreated. Therefore, older patients need to be prioritized over younger patients. The body temperature of patients admitted to hospitals needs to be monitored critically and it is important to consider seasonal fluctuations while managing cases of sepsis and allocating resources. Our findings suggest that clinicians should explore the possibility of sepsis in elderly patients admitted to emergency units with oral temperature ≥37.3°C. Risk factors for sepsis reported in this study could inform evidence-based decisions.

Citing Articles

Trends in Passive IoT Biomarker Monitoring and Machine Learning for Cardiovascular Disease Management in the U.S. Elderly Population.

Bender B, Berry J Adv Geriatr Med Res. 2023; 5(1).

PMID: 37274061 PMC: 10237513. DOI: 10.20900/agmr20230002.

References

Angus D, Lidicker J, Clermont G, Carcillo J, Pinsky M . Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001; 29(7):1303-10. DOI: 10.1097/00003246-200107000-00002. View

Sunden-Cullberg J, Rylance R, Svefors J, Norrby-Teglund A, Bjork J, Inghammar M . Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Crit Care Med. 2017; 45(4):591-599. DOI: 10.1097/CCM.0000000000002249. View

Potts 4th F, Vukov L . Utility of fever and leukocytosis in acute surgical abdomens in octogenarians and beyond. J Gerontol A Biol Sci Med Sci. 1999; 54(2):M55-8. DOI: 10.1093/gerona/54.2.m55. View

Gleckman R, Hibert D . Afebrile bacteremia. A phenomenon in geriatric patients. JAMA. 1982; 248(12):1478-81. DOI: 10.1001/jama.248.12.1478. View

Girard T, Wesley Ely E . Bacteremia and sepsis in older adults. Clin Geriatr Med. 2007; 23(3):633-47, viii. DOI: 10.1016/j.cger.2007.05.003. View

Barsic B, Beus I, Marton E, Himbele J, Klinar I . Nosocomial infections in critically ill infectious disease patients: results of a 7-year focal surveillance. Infection. 1999; 27(1):16-22. DOI: 10.1007/BF02565165. View

Suarez de la Rica A, Gilsanz F, Maseda E . Epidemiologic trends of sepsis in western countries. Ann Transl Med. 2016; 4(17):325. PMC: 5050194. DOI: 10.21037/atm.2016.08.59. View

Papaioannou V, Chouvarda I, Maglaveras N, Pneumatikos I . Temperature variability analysis using wavelets and multiscale entropy in patients with systemic inflammatory response syndrome, sepsis, and septic shock. Crit Care. 2012; 16(2):R51. PMC: 3681376. DOI: 10.1186/cc11255. View

Circiumaru B, Baldock G, Cohen J . A prospective study of fever in the intensive care unit. Intensive Care Med. 1999; 25(7):668-73. DOI: 10.1007/s001340050928. View

10.

Danai P, Sinha S, Moss M, Haber M, Martin G . Seasonal variation in the epidemiology of sepsis. Crit Care Med. 2006; 35(2):410-5. DOI: 10.1097/01.CCM.0000253405.17038.43. View

11.

Laupland K, Shahpori R, Kirkpatrick A, Ross T, Gregson D, Stelfox H . Occurrence and outcome of fever in critically ill adults. Crit Care Med. 2008; 36(5):1531-5. DOI: 10.1097/CCM.0b013e318170efd3. View

12.

Downton J, Andrews K, Puxty J . 'Silent' pyrexia in the elderly. Age Ageing. 1987; 16(1):41-4. DOI: 10.1093/ageing/16.1.41. View

13.

Buchman T, Simpson S, Sciarretta K, Finne K, Sowers N, Collier M . Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012-2018. Crit Care Med. 2020; 48(3):302-318. PMC: 7017950. DOI: 10.1097/CCM.0000000000004225. View

14.

Clemmer T, Fisher Jr C, Bone R, Slotman G, Metz C, Thomas F . Hypothermia in the sepsis syndrome and clinical outcome. The Methylprednisolone Severe Sepsis Study Group. Crit Care Med. 1992; 20(10):1395-401. DOI: 10.1097/00003246-199210000-00006. View

15.

Norman D . Fever in the elderly. Clin Infect Dis. 2000; 31(1):148-51. DOI: 10.1086/313896. View

16.

Garfield M, Ridley S, Kong A, Burns A, Blunt M, Gunning K . Seasonal variation in admission rates to intensive care units. Anaesthesia. 2001; 56(12):1136-40. DOI: 10.1046/j.1365-2044.2001.01984.x. View

17.

Fathi M, Markazi-Moghaddam N, Ramezankhani A . A systematic review on risk factors associated with sepsis in patients admitted to intensive care units. Aust Crit Care. 2018; 32(2):155-164. DOI: 10.1016/j.aucc.2018.02.005. View

18.

Moss M, Martin G . A global perspective on the epidemiology of sepsis. Intensive Care Med. 2004; 30(4):527-9. DOI: 10.1007/s00134-004-2182-z. View

19.

Varela M, Churruca J, Gonzalez A, Martin A, Ode J, Galdos P . Temperature curve complexity predicts survival in critically ill patients. Am J Respir Crit Care Med. 2006; 174(3):290-8. DOI: 10.1164/rccm.200601-058OC. View

20.

OGrady N, Barie P, Bartlett J, Bleck T, Carroll K, Kalil A . Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med. 2008; 36(4):1330-49. DOI: 10.1097/CCM.0b013e318169eda9. View