QJM Advance Access originally published online on September 10, 2007
QJM 2007 100(10):629-634; doi:10.1093/qjmed/hcm074
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Relative tachycardia in patients with sepsis: an independent risk factor for mortality
From the 1Department of Medicine E, Rabin Medical Center, Beilinson Campus, and Sackler Faculty of Medicine, Tel-Aviv University, Israel, 2Department of Clinical Microbiology and Hospital Hygiene, Freiburg University Hospital. Freiburg, Germany, 3Department of Infectious Diseases, Agostino Gemelli Hospital, Universitá Cattolica del Sacro Cuore School of Medicine, Roma, Italy, and 4University Center for Model-based Medical Decision Support, Aalborg University, Aalborg, Denmark.
Address correspondence to Dr L. Leibovici, Department of Medicine E, Beilinson Campus, Petah-Tiqva 49100, Israel. email: leibovic{at}post.tau.ac.il
Received 30 July 2006 and in revised form 17 June 2007
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Abstract |
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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/°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.