Skip to main content

Apyrexia improves the prognostic value of quick SOFA in older patients with acute pneumonia or bacteremic urinary tract infection

Infection (2022)Cite this article

Abstract

Purpose

Apyrexia is increasingly recognized as an indicator of inadequate inflammatory response in older patients with suspected infection. We aimed to evaluate whether temperature at admission could improve the prognostic value of the Quick Sequential Organ Failure Assessment (qSOFA) for predicting in-hospital mortality after acute infection.

Methods

We created a new score, named qSOFAGE (qSOFA in GEriatrics), by adding apyrexia as an item to the existing qSOFA (+ 1 point if temperature at admission ≤ 38 °C). We compared the prognostic value of the qSOFA, the qSOFAGE and temperature at admission for predicting in-hospital mortality after acute infection in two cohorts including older patients with acute pneumonia (AP) or bacteremic urinary tract infection (UTI).

Results

217 consecutive patients aged ≥ 75 hospitalized for AP (first cohort) and 105 for bacteremic UTI (second cohort) were recorded. Temperature at admission was strongly inversely correlated with in-hospital mortality in both cohorts (Odds Ratios per °C (95% Confidence Interval): 0.60 (0.45–0.80) and 0.46 (0.27–0.79) for AP and UTI. respectively). Adding the temperature ≤ 38 °C item to the qSOFA markedly improved its predictive value for in-hospital mortality in the two groups: C-statistics for qSOFAGE vs. qSOFA: 0.63 (0.53–0.73) vs. 0.56 (0.46–0.67) in AP cohort; 0.74 (0.58–0.89) vs. 0.69 (0.53–0.85) in UTI cohort. For patients with qSOFAGE ≥ 3, in-hospital mortality reached 37% after AP and 55% after bacteremic UTI.

Conclusion

Temperature at admission was strongly correlated with mortality in these two cohorts of older patients hospitalized for acute infection. The next step will be to validate this score in cohorts of older patients with suspected infection.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10. https://doi.org/10.1001/jama.2016.0287.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hyernard C, Breining A, Duc S, et al. Atypical presentation of bacteremia in older patients is a risk factor for death. Am J Med. 2019;132(11):1344-1352.e1. https://doi.org/10.1016/j.amjmed.2019.04.049.

    Article  PubMed  Google Scholar 

  3. Laborde C, Bador J, Hacquin A, et al. Atypical presentation of bacteremic urinary tract infection in older patients: frequency and prognostic impact. Diagnostics. 2021;11(3):523. https://doi.org/10.3390/diagnostics11030523.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wester AL, Dunlop O, Melby KK, Dahle UR, Wyller TB. Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis. 2013;13:346. https://doi.org/10.1186/1471-2334-13-346.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hernández C, Fehér C, Soriano A, et al. Clinical characteristics and outcome of elderly patients with community-onset bacteremia. J Infect. 2015;70(2):135–43. https://doi.org/10.1016/j.jinf.2014.09.002.

    Article  PubMed  Google Scholar 

  6. Inghammar M, Sunden-Cullberg J. Prognostic significance of body temperature in the emergency department vs the ICU in patients with severe sepsis or septic shock: a nationwide cohort study. Sarkar A. PLoS ONE. 2020;15(12):e0243990. https://doi.org/10.1371/journal.pone.0243990.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Pien BC, Sundaram P, Raoof N, et al. The clinical and prognostic importance of positive blood cultures in adults. Am J Med. 2010;123(9):819–28. https://doi.org/10.1016/j.amjmed.2010.03.021.

    Article  PubMed  Google Scholar 

  8. Forstner C, Patchev V, Rohde G, et al. Rate and predictors of bacteremia in afebrile community-acquired pneumonia. Chest. 2020;157(3):529–39. https://doi.org/10.1016/j.chest.2019.10.006.

    Article  PubMed  Google Scholar 

  9. Yoshikawa TT, Reyes BJ, Ouslander JG. Sepsis in older adults in long-term care facilities: challenges in diagnosis and management. J Am Geriatr Soc. 2019;67(11):2234–9. https://doi.org/10.1111/jgs.16194.

    Article  PubMed  Google Scholar 

  10. Bastoni D, Ticinesi A, Lauretani F, et al. Application of the sepsis-3 consensus criteria in a geriatric acute care unit: a prospective study. JCM. 2019;8(3):359. https://doi.org/10.3390/jcm8030359.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Brunetti E, Isaia G, Rinaldi G, et al. Comparison of diagnostic accuracies of qSOFA, NEWS, and MEWS to identify sepsis in older inpatients with suspected infection. J Ame Med Dir Assoc. 2021. https://doi.org/10.1016/j.jamda.2021.09.005.

    Article  Google Scholar 

  12. Remelli F, Castellucci F, Vitali A, et al. Predictive value of geriatric-quickSOFA in hospitalized older people with sepsis. BMC Geriatr. 2021;21(1):241. https://doi.org/10.1186/s12877-021-02182-1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Boonmee P, Ruangsomboon O, Limsuwat C, Chakorn T. Predictors of mortality in elderly and very elderly emergency patients with sepsis: a retrospective study. WestJEM. 2020. https://doi.org/10.5811/westjem.2020.7.47405.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ramos JGR, da Hora PR, Teixeira MB, et al. Prognostic ability of quick-SOFA across different age groups of patients with suspected infection outside the intensive care unit: a cohort study. J Crit Care. 2018;47:178–84. https://doi.org/10.1016/j.jcrc.2018.07.008.

    Article  PubMed  Google Scholar 

  15. Putot A, Tetu J, Perrin S, et al. A new prognosis score to predict mortality after acute pneumonia in very elderly patients. J Am Med Dir Assoc. 2016;17(12):1123–8. https://doi.org/10.1016/j.jamda.2016.07.018.

    Article  PubMed  Google Scholar 

  16. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Supplement 2):S27–72. https://doi.org/10.1086/511159.

    Article  CAS  PubMed  Google Scholar 

  17. Putot A, Tetu J, Perrin S, et al. Impact of microbiological samples in the hospital management of community-acquired, nursing home-acquired and hospital-acquired pneumonia in older patients. Eur J Clin Microbiol Infect Dis. 2016. https://doi.org/10.1007/s10096-015-2565-9.

    Article  PubMed  Google Scholar 

  18. Ramos-Rincón JM, Fernández-Gil A, Merino E, et al. The quick Sepsis-related organ failure assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: a retrospective observational study. Sci Rep. 2019;9(1):15075. https://doi.org/10.1038/s41598-019-51439-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Jiang J, Yang J, Jin Y, Cao J, Lu Y. Role of qSOFA in predicting mortality of pneumonia: a systematic review and meta-analysis. Medicine. 2018;97(40): e12634. https://doi.org/10.1097/MD.0000000000012634.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yoshikawa TT, Norman DC. Geriatric infectious diseases: current concepts on diagnosis and management. J Am Geriatr Soc. 2017;65(3):631–41. https://doi.org/10.1111/jgs.14731.

    Article  PubMed  Google Scholar 

  21. Norman DC. Clinical features of infection in older adults. Clin Geriatr Med. 2016;32(3):433–41. https://doi.org/10.1016/j.cger.2016.02.005.

    Article  PubMed  Google Scholar 

  22. Mortensen EM, Coley CM, Singer DE, et al. Causes of death for patients with community-acquired pneumonia: results from the pneumonia patient outcomes research team cohort study. Arch Intern Med. 2002;162(9):1059–64.

    Article  PubMed  Google Scholar 

  23. Waalen J, Buxbaum JN. Is older colder or colder older? The association of age with body temperature in 18,630 individuals. J Gerontol A Biol Sci Med Sci. 2011;66(5):487–92. https://doi.org/10.1093/gerona/glr001.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Suzanne Rankin for proofreading the manuscript.

Funding

The authors have not disclosed any funding.

Author information

Authors and Affiliations

  1. Médecine Interne Gériatrie, Centre Hospitalier Universitaire de Nîmes, Nîmes, France

    Caroline Laborde

  2. Médecine Interne Gériatrie, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France

    Martha Deidda & Patrick Manckoundia

  3. Laboratoire de Microbiologie, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France

    Julien Bador

  4. Soins de Suite et Réadaptation Gériatrique, Hôpitaux du Pays du Mont Blanc, Chamonix, France

    Sophie Putot

  5. Institut National de la Santé et de la Recherche Médicale U1093 Cognition, Action et Plasticité Sensorimotrice, Université de Bourgogne, Dijon, France

    Patrick Manckoundia

  6. Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, Sallanches, France

    Alain Putot

  7. Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne, Dijon, France

    Alain Putot

Authors
  1. Caroline Laborde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martha Deidda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julien Bador
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sophie Putot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Manckoundia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alain Putot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alain Putot.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Consent to publish was not required for this observational study using anonymized data.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Laborde, C., Deidda, M., Bador, J. et al. Apyrexia improves the prognostic value of quick SOFA in older patients with acute pneumonia or bacteremic urinary tract infection. Infection (2022). https://doi.org/10.1007/s15010-022-01953-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s15010-022-01953-1

Keywords

  • Immunosenescence
  • Sepsis
  • Temperature
  • Pneumonia
  • Urinary tract infection
  • Aged