Hospitalized acute patients with fever and severe infection have lower mortality than patients with hypo- or normothermia: a follow-up study

OBJECTIVES: 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 hypo-, normo- 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 (<36.0C), normothermia (36.0C-38.0C), and fever (>38.0C). Severe infection was defined as a discharge diagnosis indicating infection combined with organ failure within the first 24 hours after arrival. Multivariable Cox regression analysis was computed to assess the association between temperature and 30-day mortality.

RESULTS: A total of 2,128 patients with severe infection were included. 3.0% (N=64) were hypothermic, 57.1% (N=1,216) 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.