低体温症を伴う敗血症患者における温度推移：氷が溶け始めるとき - 後ろ向きコホート研究

ObjectiveSepsis is a heterogeneous syndrome, and identifying its subphenotypes may enhance clinical management. Hypothermia may be an indicator of poor outcomes in septic patients.MethodsThis retrospective observational study included septic patients with hypothermia identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Group-based trajectory modeling was used to identify temperature trajectory subphenotypes. Cox proportional hazards model, inverse probability of treatment weighting, and doubly robust estimation were used to explore the association between the subphenotypes and clinical outcomes.ResultsA total of 1816 patients were included in the analysis, and their 48-hour temperature trajectories were categorized into three classes. The Cox proportional hazard model revealed that compared with class 2, class 1 was associated with increased 7-day mortality (HR 1.90; 95% CI 1.18-3.07; P = 0.009), whereas class 3 was associated with reduced 28-day mortality (HR 0.81; 95% CI 0.66-1.00; P = 0.045). The doubly robust estimation methods yield similar results.ConclusionsWe identified three temperature trajectories from septic patients with hypothermia, with significant variability in clinical characteristics and outcomes. A better understanding of temperature trajectories may help with the early identification of deteriorating patients with "cold sepsis."