Temperature Trajectories Are Associated With the Prognosis of Septic Patients

Sepsis is a heterogeneous clinical syndrome, and identification of its subphenotypes is essential. We aimed to investigate the correlation between the different trajectories of temperature and outcomes in septic patients.

This was a retrospective cohort study that included sepsis patients admitted to the intensive care unit (ICU) of a tertiary care hospital. Patients' temperature data were collected during the first 48 h after ICU admission, and patients' temperature trajectories were identified using growth-based trajectory modeling (GBTM). A multivariable logistic regression model was performed to assess the independent association of clinical outcomes. External validation was conducted using the MIMIC-IV database.

A total of 312 patients with sepsis were included. Four temperature trajectories were identified: hypothermia group (n = 33), fever and rapid temperature drop group (n = 45), persistently elevated temperature group (n = 63), and normothermia group (n = 171). Hypothermia patients exhibited the highest mortality and incidence of hospital-acquired bloodstream infections (HA-BSIs). Multivariable logistic regression showed that compared with the normothermia group, patients in the hypothermia group (OR 2.73; 95% CI 1.10-6.73; p = 0.030) and the persistently elevated temperature group (OR 3.40; 95% CI 1.74-6.67; p < 0.001) had significantly higher in-hospital mortality. Similar subphenotypes were observed in the MIMIC-IV cohort. Further analysis reached similar results in the MIMIC-IV dataset.

This study used longitudinal body temperature data to identify the subphenotypes of sepsis, with significant variability in in-hospital mortality and HA-BSI. A better understanding of the temperature trajectory may be helpful in identifying deteriorating septic patients in advance.