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패혈성 쇼크 환자에서 응급의료센터에서 측정된 체온과 예후와의 연관성

Association between body temperature measured at the emergency department with prognosis in septic shock patients

대한응급의학회지 2020년 31권 4호 p.346 ~ 354
최주환, 박유석, 정성필, 신태건, 김원영, 최성혁, 조유환, 강구현, 신종환, 임태호, 한갑수, 서길준,
소속 상세정보
최주환 ( Choi Ju-Hwan ) - Yonsei University College of Medicine Department of Emergency Medicine
박유석 ( Park Yoo-Seok ) - Yonsei University College of Medicine Department of Emergency Medicine
정성필 ( Chung Sung-Phil ) - Yonsei University College of Medicine Department of Emergency Medicine
신태건 ( Shin Tae-Gun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Emergency Medicine
김원영 ( Kim Won-Young ) - University of Ulsan College of Medicine Asan Medical Center Department of Emergency Medicine
최성혁 ( Choi Sung-Hyuk ) - Korea University College of Medicine Korea University Guro Hospital Department of Emergency Medicine
조유환 ( Jo You-Hwan ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Emergency Medicine
강구현 ( Kang Gu-Hyun ) - Hallym University College of Medicine Hallym University Kangnam Sacred Heart Hospital Department of Emergency Medicine
신종환 ( Shin Jong-Hwan ) - Seoul National University College of Medicine Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Emergency Medicine
임태호 ( Lim Tae-Ho ) - Hanyang University College of Medicine Department of Emergency Medicine
한갑수 ( Han Kap-Su ) - Korea University College of Medicine Korea University Anam Hospital Department of Emergency Medicine
서길준 ( Suh Gil-Joon ) - Seoul National University College of Medicine Department of Emergency Medicine

Abstract


Objective: Prior studies have explored the relationship between initial body temperature (BT) and mortality in patients with sepsis in the emergency department (ED). However, there has been no study on whether or not changes in BT are associated with prognosis in these patients. We hypothesize that BT measured upon ED arrival and septic shock registry enroll time are related to the prognosis of patients with septic shock.

Method: We conducted a prospective, observational, registry-based study. Each patient was assigned to 1 of 4 groups according to BT upon ED arrival and registry enrollment. Odds ratios for 28-day mortality according to the patient group were estimated using multivariable logistic regression. We also conducted logistic regression sensitivity analysis, except for patients whose time interval between arrival and enrollment was less than 1 hour.

Results: A total of 2,138 patients with septic shock were included. The 28-day mortalities were 13.7%, 11.2%, 13.0%, and 25.8% in groups 1, 2, 3, and 4, respectively (P<0.001). After adjusting for age, sex, mean atrial pressure, respiratory rate, Sequential Organ Failure Assessment score, lactate concentration, comorbidity, and suspicious infection focus, the risk of mortality was significantly low in patients from group 1 (adjusted odds ratio [aOR], 0.433; 95% confidence interval [CI], 0.310-0.604) and group 2 (aOR, 0.540; 95% CI, 0.336-0.868) compared with group 4. In the sensitivity analysis, group based on BT measured upon ED arrival and registry enrollment also remained an independent predictor of mortality.

Conclusion: Afebrile status upon ED arrival and registry enrollment were strongly associated with higher 28-day mortality in patients with septic shock.

키워드

Septic shock; Body temperature; Mortality; Emergency department

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