体温高峰与重症监护室内脓毒症患者预后的相关性

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Abstract Objective: To explore the correlation between temperature and prognosis in sepsis patients. Methods: The clinical data of 176 cases of sepsis patients admitted to intensive care unit of Quzhou People’ Hospital during January 2013 to May 2017 were retrospectively analyzed. They were divided into 4 groups according to the highest body temperature (MAXICU) recorded during ICU stay: ≤37.4 ℃ group, 37.5-38.4 ℃ group, 38.5-39.4 ℃ group, ≥39.5 ℃ group and all their clinical data were recorded. The relationship between the temperature in each group and 28-mortality was analyzed by Cox regression; the survival rates was calculated using the Kaplan-Meier method and the differences in each group were assessed by log-rank test. Multivariate Cox proportional hazard regression analysis was used to analyze the risk factors of 28-mortality in patients with sepsis. Finally, multivariate dummy variable test was performed. Results: Of the four groups, the 28-day death occurred in 80 cases, with a mortality rate of 45.4%. The median survival time of ≤37.4 ℃ group, 37.5-38.4 ℃ group, 38.5-39.4 ℃ group and 38.5-39.4 ℃ group was 28 days, 13 days, 28 days and 28 days respectively, which involved 16 cases, 39 cases, 17 cases and 8 cases of respectively. Kaplan-Meier survival curve analysis showed the mortality rate between the four groups within 28 days after entering into ICU was statistically different (χ2 log-rank=16.377, P=0.001). Log-rank method was used to compare between groups. The survival distribution was statistically different between 38.5-39.4 ℃ group and 37.5-38.4 ℃ group (P<0.001). Significant difference also existed between ≥39.5 ℃ group and 37.5-38.4 ℃ group (P=0.013), but there’s no statistical difference between ≤37.4 ℃ group and 37.5-38.4 ℃ group (P>0.05) in the survival distribution. The maximum temperature taken in ICU (37.5-38.4 ℃ group, ≤37.4 ℃ group, 38.5-39.4 ℃ group, ≥39.5 ℃ group), acute physiology and chronic health evaluation (APACHE II) score, the use of blood products, international normalized ratio level (INR), PaCO2, age, gender were used as the independent variables and the 28-day mortality after patients entered ICU as the dependent variable to perform the single factor Cox regression and multi-factor Cox regression. Single factor Cox regression analysis showed that the maximum body temperature after entering ICU (HR=0.722, 95%CI=0.562-0.927, P=0.011), APACHE II score (HR=1.057, 95%CI=1.031-1.084, P<0.001), use of blood products (HR= 1.650, 95%CI=1.061-2.566, P=0.026), the level of INR (HR=2.179, 95%CI=1.054-4.509, P=0.036), PaCO2 level (HR=0.978, 95%CI=0.961-0.995, P=0.01) were the risk factors of the death in sepsis patients within 28 days after ICU. Multivariate COX regression analysis showed that the body temperature was still the independent risk factor that affected the patient’s death within 28 days after entering the ICU (P=0.045). Further multivariate dummy variable test for temperature was performed. The 37.5-38.4 ℃ group was taken as the control group (dummy variable), the MAXICU=38.5-39.4 ℃ was the independent protective factor of the 28-day mortality for the septic patients in ICU, the 28-day mortality risk was 41.2% as much as the control group (95%CI=0.221-0.771, P=0.005), but there was no obvious correlation between MAXICU=36.5-37.4 ℃, MAXICU≥39.5 ℃ and the 28-day mortality in ICU (HR=0.930, 95%CI=0.448-1.930, P=0.846; HR=0.560, 95%CI=0.237-1.323, P=0.186). Conclusion: MAXICU=38.5-39.4 ℃ may reduce the mortality of septic patients in ICU.

Key words： temperature sepsis prognosis Cox regression

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	MAO Xiaoqiang
	LOU Bingheng
	CUI Yiming

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2018/V48/I8/582

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