Annals of Hematology

, Volume 94, Issue 5, pp 857–864 | Cite as

Association between early peak temperature and mortality in neutropenic sepsis

  • Robert Weinkove
  • Michael Bailey
  • Rinaldo Bellomo
  • Manoj K. Saxena
  • Constantine S. Tam
  • David V. Pilcher
  • Richard Beasley
  • Paul J. Young
Original Article

Abstract

Fever is often the first sign of neutropenic infection, but its prognostic impact has not been established. We aimed to determine whether early peak temperature is associated with mortality in patients with neutropenic sepsis admitted to intensive care units (ICUs). We used a database of admissions to 157 ICUs in Australia and New Zealand between 2005 and 2013 to seek an association between peak temperature within the first 24 h in ICU and in-hospital mortality in neutropenic and non-neutropenic sepsis. Odds ratios for in-hospital death were calculated for four temperature bands, adjusting for illness severity. Two patient cohorts were identified: neutropenic sepsis (N = 4027) and non-neutropenic sepsis (N = 114,040). In-hospital mortality was higher in neutropenic sepsis than non-neutropenic sepsis. In both cohorts, early peak temperature below 36.5 °C was associated with significantly increased mortality compared to normothermia. Among non-neutropenic patients, an early peak temperature of 37.5 °C or higher was associated with reduced mortality compared to normothermia. In contrast, in patients with neutropenic sepsis, fever was not associated with reduced mortality compared to normothermia. Similar findings were seen in a subgroup of the neutropenic sepsis cohort with a documented haematological malignancy. In neutropenic sepsis patients admitted to ICU, a temperature below 36.5 °C is associated with increased mortality compared with normothermia. In contrast to non-neutropenic sepsis, fever was not associated with a significant reduction in mortality in neutropenic patients. Interventional studies are needed to determine whether physical or pharmacological measures to reduce fever influence outcomes during neutropenic infections.

Keywords

Neutropenia Fever Sepsis Body temperature Critical care 

Supplementary material

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Appendix S1(DOCX 90 kb)
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Appendix S2(DOCX 115 kb)
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Appendix S3(DOCX 83 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Robert Weinkove
    • 1
    • 2
    • 3
  • Michael Bailey
    • 4
  • Rinaldo Bellomo
    • 5
    • 6
  • Manoj K. Saxena
    • 7
  • Constantine S. Tam
    • 8
  • David V. Pilcher
    • 5
    • 9
  • Richard Beasley
    • 10
  • Paul J. Young
    • 10
    • 11
  1. 1.Wellington Blood & Cancer CentreCapital & Coast District Health BoardWellingtonNew Zealand
  2. 2.Vaccine Research GroupMalaghan Institute of Medical ResearchWellingtonNew Zealand
  3. 3.Department of Pathology and Molecular MedicineUniversity of Otago WellingtonWellingtonNew Zealand
  4. 4.Australian and New Zealand Intensive Care Research CentreMonash UniversityMelbourneAustralia
  5. 5.Australian and New Zealand Intensive Care Society Centre for Outcome and Resource EvaluationMelbourneAustralia
  6. 6.Intensive Care Unit, Austin HospitalMelbourneAustralia
  7. 7.St George Clinical SchoolUniversity of New South WalesSydneyAustralia
  8. 8.Peter MacCallum Cancer CentreMelbourneAustralia
  9. 9.Intensive Care Unit, Alfred HospitalMelbourneAustralia
  10. 10.Medical Research Institute of New ZealandWellingtonNew Zealand
  11. 11.Intensive Care Unit, Capital & Coast District Health BoardWellingtonNew Zealand

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