Anne M Drewry1, Brian M Fuller, Lee P Skrupky, Richard S Hotchkiss. 1. 1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO. 2Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO. 3Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO. 4Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Abstract
OBJECTIVE: To determine whether hypothermia within 24 hours of sepsis diagnosis is associated with development of persistent lymphopenia, a feature of sepsis-induced immunosuppression. DESIGN: Retrospective cohort study. SETTING: A 1,200-bed university-affiliated tertiary care hospital. PATIENTS: Adult patients diagnosed with bacteremia and sepsis within 5 days of hospital admission between January 1, 2010, and July 31, 2012. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Leukocyte counts were recorded during the first 4 days following sepsis diagnosis. Persistent lymphopenia was defined as an absolute lymphocyte count less than 1.2 cells/μL×10(3) present on the fourth day after diagnosis. Of the 445 patients with sepsis included, hypothermia developed in 64 patients (14.4%) (defined as a body temperature<36.0°C) within 24 hours of sepsis diagnosis. Hypothermia was a significant independent predictor of persistent lymphopenia (adjusted odds ratio, 2.70 [95% CI, 1.10, 6.60]; p=0.03) after accounting for age, disease severity, comorbidities, source of bacteremia, and type of organism. Compared with the nonhypothermic patients, hypothermic patients had higher 28-day (50.0% vs 24.9%, p<0.001) and 1-year mortality (60.9% vs 47.0%, p=0.001). CONCLUSIONS: Hypothermia is associated with higher mortality and an increased risk of persistent lymphopenia in patients with sepsis, and it may be an early clinical predictor of sepsis-induced immunosuppression.
OBJECTIVE: To determine whether hypothermia within 24 hours of sepsis diagnosis is associated with development of persistent lymphopenia, a feature of sepsis-induced immunosuppression. DESIGN: Retrospective cohort study. SETTING: A 1,200-bed university-affiliated tertiary care hospital. PATIENTS: Adult patients diagnosed with bacteremia and sepsis within 5 days of hospital admission between January 1, 2010, and July 31, 2012. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Leukocyte counts were recorded during the first 4 days following sepsis diagnosis. Persistent lymphopenia was defined as an absolute lymphocyte count less than 1.2 cells/μL×10(3) present on the fourth day after diagnosis. Of the 445 patients with sepsis included, hypothermia developed in 64 patients (14.4%) (defined as a body temperature<36.0°C) within 24 hours of sepsis diagnosis. Hypothermia was a significant independent predictor of persistent lymphopenia (adjusted odds ratio, 2.70 [95% CI, 1.10, 6.60]; p=0.03) after accounting for age, disease severity, comorbidities, source of bacteremia, and type of organism. Compared with the nonhypothermic patients, hypothermicpatients had higher 28-day (50.0% vs 24.9%, p<0.001) and 1-year mortality (60.9% vs 47.0%, p=0.001). CONCLUSIONS:Hypothermia is associated with higher mortality and an increased risk of persistent lymphopenia in patients with sepsis, and it may be an early clinical predictor of sepsis-induced immunosuppression.
Authors: Paul Jeffrey Young; Manoj Saxena; Richard Beasley; Rinaldo Bellomo; Michael Bailey; David Pilcher; Simon Finfer; David Harrison; John Myburgh; Kathryn Rowan Journal: Intensive Care Med Date: 2012-01-31 Impact factor: 17.440
Authors: Mitchell M Levy; Mitchell P Fink; John C Marshall; Edward Abraham; Derek Angus; Deborah Cook; Jonathan Cohen; Steven M Opal; Jean-Louis Vincent; Graham Ramsay Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: M M Arons; A P Wheeler; G R Bernard; B W Christman; J A Russell; R Schein; W R Summer; K P Steinberg; W Fulkerson; P Wright; W D Dupont; B B Swindell Journal: Crit Care Med Date: 1999-04 Impact factor: 7.598
Authors: Christian Meisel; Joerg C Schefold; Rene Pschowski; Tycho Baumann; Katrin Hetzger; Jan Gregor; Steffen Weber-Carstens; Dietrich Hasper; Didier Keh; Heidrun Zuckermann; Petra Reinke; Hans-Dieter Volk Journal: Am J Respir Crit Care Med Date: 2009-07-09 Impact factor: 21.405
Authors: Anne M Drewry; Navdeep Samra; Lee P Skrupky; Brian M Fuller; Stephanie M Compton; Richard S Hotchkiss Journal: Shock Date: 2014-11 Impact factor: 3.454
Authors: Dorothea D Jenkins; Timothy Lee; Cody Chiuzan; Jessica K Perkel; Laura Grace Rollins; Carol L Wagner; Lakshmi P Katikaneni; W Thomas Bass; David A Kaufman; Michael J Horgan; Sheela Laungani; Laurence M Givelichian; Koravangatta Sankaran; Jerome Y Yager; Renee Martin Journal: Pediatr Crit Care Med Date: 2013-10 Impact factor: 3.624
Authors: Harding H Luan; Andrew Wang; Brandon K Hilliard; Fernando Carvalho; Connor E Rosen; Amy M Ahasic; Erica L Herzog; Insoo Kang; Margaret A Pisani; Shuang Yu; Cuiling Zhang; Aaron M Ring; Lawrence H Young; Ruslan Medzhitov Journal: Cell Date: 2019-08-08 Impact factor: 41.582
Authors: Sivasubramanium V Bhavani; Kyle A Carey; Emily R Gilbert; Majid Afshar; Philip A Verhoef; Matthew M Churpek Journal: Am J Respir Crit Care Med Date: 2019-08-01 Impact factor: 21.405
Authors: Christen E Salyer; Christian B Bergmann; Richard S Hotchkiss; Peter A Crisologo; Charles C Caldwell Journal: J Surg Res Date: 2022-02-05 Impact factor: 2.417
Authors: Matthew Lindeblad; Alexander Lyubimov; Richard van Breemen; Kamil Gierszal; Guy Weinberg; Israel Rubinstein; Douglas L Feinstein Journal: Toxicol Sci Date: 2018-10-01 Impact factor: 4.849
Authors: Anne M Drewry; Enyo A Ablordeppey; Ellen T Murray; Catherine M Dalton; Brian M Fuller; Marin H Kollef; Richard S Hotchkiss Journal: Shock Date: 2018-10 Impact factor: 3.454