Body temperature at sepsis recognition as a nursing bedside surveillance parameter: a multicenter observational cohort study

Early recognition and surveillance of sepsis rely on timely interpretation of vital signs by nurses. Body temperature is routinely measured at bedside, but its prognostic meaning at sepsis recognition remains uncertain. This study evaluated whether body temperature at sepsis recognition was associated with hospital mortality and markers of organ dysfunction in adults with sepsis or septic shock.

A multicenter observational cohort study was conducted in two Brazilian hospitals between March 2021 and January 2022. Adults with sepsis or septic shock were enrolled at sepsis protocol activation. Body temperature and other vital signs were recorded at bedside, and blood samples were collected to assess lactate, plasma nitrite/nitrate, leukocytes, platelets, creatinine, urea, and prothrombin time. Patients were classified as hypothermic (< 36.0 °C), normothermic (36.0-37.9 °C), or febrile (≥ 38.0 °C). Associations between temperature and clinical or laboratory markers were assessed using correlation analyses. Multivariable logistic regression evaluated the association between body temperature and hospital mortality after adjustment for age, sex, and sepsis severity.

The cohort included 166 patients; 98 (59.1%) had sepsis and 68 (40.9%) had septic shock. Overall hospital mortality was 68.1%. Non-survivors had lower body temperature and a more severe clinical and laboratory profile, including higher lactate and nitrite/nitrate concentrations, higher creatinine and urea, lower leukocyte and platelet counts, and prolonged prothrombin time. Mortality was 72.7% in hypothermic patients, 67.7% in normothermic patients, and 64.7% in febrile patients. In the adjusted model, body temperature was not independently associated with hospital mortality (odds ratio per 1 °C increase = 0.937; 95% confidence interval 0.687-1.278; P = 0.681). Older age, male sex, and septic shock were independently associated with mortality. Body temperature showed weak inverse correlations with nitrite/nitrate and prothrombin time, but no significant correlation with lactate or renal markers.

At sepsis recognition, lower body temperature was observed among non-survivors but did not independently predict hospital mortality after adjustment for key clinical factors. For nursing practice, body temperature should be interpreted as part of integrated bedside surveillance, together with clinical deterioration and laboratory evidence of organ dysfunction, rather than as a standalone prognostic marker.