Key result
Excessive tachycardia relative to fever was significantly associated with increased 30-day mortality in patients with SIRS (OR 1.54; 95% CI 1.10-2.17).
Why the study?
Is excessive tachycardia relative to fever an independent risk factor for 30-day mortality in patients with SIRS/sepsis?
Observational (n=3,382)
Yes
Is excessive tachycardia relative to fever an independent risk factor for 30-day mortality in patients with SIRS/sepsis?
Odds Ratio: 1.54 (95% CI 1.1–2.17)
Excessive tachycardia relative to fever is an independent predictor of 30-day mortality in patients with SIRS or sepsis, suggesting a detrimental effect of excess sympathetic activation.
May warrant monitoring but not rate control in SIRS; leaves open whether blunting excess tachycardia improves survival.
BACKGROUND: Excess activation of the sympathetic nervous system may be a risk factor for mortality in patients with the systemic inflammatory response syndrome (SIRS) or sepsis. AIM: To examine whether excessive tachycardia, relative to the degree of fever is an independent risk factor for death in patients with SIRS. DESIGN: Prospective observational study. SETTING: Departments of medicine in three university hospitals in Israel, Germany and Italy. METHODS: We collected data for 3382 patients with SIRS, whether community- or hospital-acquired, 91% with sepsis, as part of an ongoing trial. RESULTS: Overall 30-day mortality was 12% (408/3382). The pulse/temperature ratio was significantly higher in patients who died than in survivors: mean +/- SD 2.55 +/- 0.57 vs. 2.40 +/- 0.48 bpm/ degrees C (p < 0.0001). Excessive tachycardia was significantly associated with a mortality in a logistic model accounting for other strong predictors of mortality (OR 1.54, 95%CI 1.10-2.17). Patients with septic shock were the only group for whom this association did not hold. DISCUSSION: Our data are compatible with the hypothesis that some patients with sepsis experience an excess activation of the sympathetic nervous system, leading to a fatal outcome.
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Leibovici et al. (2007) conducted an observational in Systemic inflammatory response syndrome (SIRS) or sepsis (n=3,382). Excessive tachycardia relative to fever was evaluated on 30-day mortality (OR 1.54, 95% CI 1.10-2.17). Excessive tachycardia relative to fever was significantly associated with increased 30-day mortality in patients with SIRS (OR 1.54; 95% CI 1.10-2.17).
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