Temperature Trajectories Correlate With Cardiac Function in Patients With Sepsis.

Abstract

Objectives: Body temperature trajectories of infected patients are associated with dynamic clinical and immune responses to infection. Our objective was to evaluate the association between temperature trajectory subphenotypes and cardiac dysfunction determined by echocardiography.

Design: Retrospective cohort study.

Setting: Four hospitals within an academic healthcare system from 2016 to 2019.

Patients: Adult patients with suspicion of infection who underwent transthoracic echocardiography within 48 hours of admission.

Interventions: Using a validated model, patients were classified into four temperature trajectory subphenotypes. The primary outcome compared between subphenotypes was left ventricular dysfunction, defined as ejection fraction less than or equal to 50%.

Measurements and main results: One thousand nine hundred twenty-three hospitalized septic patients were classified into four subphenotypes: "hyperthermic, slow resolvers" (n = 264, 14%), "hyperthermic, fast resolvers" (302, 16%), "normothermic" patients (903, 47%), and "hypothermic" patients (454, 24%). Left ventricular and right ventricular dysfunction was significantly different between subphenotypes. Hypothermic patients exhibited the highest levels of left ventricular dysfunction (208, 46%; p < 0.01) and right ventricular dysfunction (169, 39%; p < 0.01). In the multivariable logistic regression analysis, adjusting for demographics, comorbidities, and severity of illness, membership in the hypothermic group (odds ratio, 2.65; 95% CI, 1.87-3.80; p < 0.01) was associated with significantly reduced left ventricular ejection fraction compared with hyperthermic slow resolvers as reference. Hypothermic patients also had the highest levels of vasopressor use (27%; p < 0.01), inotrope use (11%; p < 0.01), and in-hospital mortality (12%; p < 0.01).

Conclusions: Temperature trajectories in sepsis are significantly associated with cardiac dysfunction, with hypothermic patients having the highest odds ratio of both left and right ventricular dysfunction. Bedside temperature monitoring could be a readily available marker to prompt early echocardiographic assessment, though further studies are needed to validate the relationship.