Is body temperature an independent predictor of mortality in hip fracture patients?

Faizi, Murtuza; Farrier, Adam James; Venkatesan, M; Thomas, Christopher; Uzoigwe, Chika Edward; Balasubramanian, Siva; Smith, Robert P.

doi:10.1016/j.injury.2014.09.024

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…Thus temperature could be another variable in the cluster of traits linking obesity and activation of the sympathetic nervous system. 29 30 31 Interestingly, while our temperature effects were estimated over longer periods, some small studies have found that hypothermia is linked to increased mortality for acute events (eg, in hip fractures), 32 potentially implying a different physiology in short term versus long term temperature regulation.…”

Section: Discussionmentioning

confidence: 99%

Individual differences in normal body temperature: longitudinal big data analysis of patient records

Obermeyer

Jasmeet

Mullainathan

2017

BMJ

141

144

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ObjectiveTo estimate individual level body temperature and to correlate it with other measures of physiology and health.DesignObservational cohort study.SettingOutpatient clinics of a large academic hospital, 2009-14.Participants35 488 patients who neither received a diagnosis for infections nor were prescribed antibiotics, in whom temperature was expected to be within normal limits.Main outcome measuresBaseline temperatures at individual level, estimated using random effects regression and controlling for ambient conditions at the time of measurement, body site, and time factors. Baseline temperatures were correlated with demographics, medical comorbidities, vital signs, and subsequent one year mortality.ResultsIn a diverse cohort of 35 488 patients (mean age 52.9 years, 64% women, 41% non-white race) with 243 506 temperature measurements, mean temperature was 36.6°C (95% range 35.7-37.3°C, 99% range 35.3-37.7°C). Several demographic factors were linked to individual level temperature, with older people the coolest (–0.021°C for every decade, P<0.001) and African-American women the hottest (versus white men: 0.052°C, P<0.001). Several comorbidities were linked to lower temperature (eg, hypothyroidism: –0.013°C, P=0.01) or higher temperature (eg, cancer: 0.020, P<0.001), as were physiological measurements (eg, body mass index: 0.002 per m/kg2, P<0.001). Overall, measured factors collectively explained only 8.2% of individual temperature variation. Despite this, unexplained temperature variation was a significant predictor of subsequent mortality: controlling for all measured factors, an increase of 0.149°C (1 SD of individual temperature in the data) was linked to 8.4% higher one year mortality (P=0.014).ConclusionsIndividuals’ baseline temperatures showed meaningful variation that was not due solely to measurement error or environmental factors. Baseline temperatures correlated with demographics, comorbid conditions, and physiology, but these factors explained only a small part of individual temperature variation. Unexplained variation in baseline temperature, however, strongly predicted mortality.

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Section: Discussionmentioning

confidence: 99%

Individual differences in normal body temperature: longitudinal big data analysis of patient records

Obermeyer

Jasmeet

Mullainathan

2017

BMJ

141

144

View full text Add to dashboard Cite

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“…Methodology differs markedly between studies and when similar outcomes are studied in similar populations with similar interventions, different results are reported. Some studies noted statistically significant increases in mortality and in 30-day readmission rates 16,17 while others noted no difference at all. This makes it difficult to draw reliable conclusions or choose best future direction due to the contradicting, heterogeneous evidence available.…”

Section: Discussionmentioning

confidence: 99%

“…A later follow up study 17 with an additional 285 patients, found that 407/1066 (38.2%) were <36.5 C. Adjusted for the 7 most potent prognostic indicators for mortality, they found that body temperature <36.5 C increased risk of death by 2.1 times, reinforcing the need for careful and aggressive temperature control. These 2 studies are the first of their kind, investigating how low body temperature impacts outcomes.…”

Section: Hypothermia May Increase Readmission and Mortalitymentioning

confidence: 97%

Too Cool? Hip Fracture Care and Maintaining Body Temperature

Arkley

Taher

Dixon

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

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“…Temperature dysregulation is common among patients who have critical illness, and admission BT is included in risk stratification parameters such as SAPS2 or APACHE2 (higher or lower temperature) [13,14]. The impact of BT abnormalities (especially fever and hypothermia) for neurological outcome in patients after cardiopulmonary resuscitation [5,15] or the impact of BT alteration in trauma patients [16] has been investigated. However, most of these studies focus on the relevance of modulating thermoregulation (actively or passively [6]) during the stay [4,17] in the ICU and did not indicate any significance of admission BT to patient prognosis.…”

Section: Discussionmentioning

confidence: 99%

Admission Body Temperature in Critically Ill Patients as an Independent Risk Predictor for Overall Outcome

et al. 2019

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Introduction: Body temperature (BT) abnormalities are frequently observed in critically ill patients. We aimed to assess admission BT in a heterogeneous critically ill patient population admitted to an intensive care unit (ICU) as a prognostic parameter for intra-ICU and long-term mortality. Methods: A total of 6,514 medical patients (64 ± 15 years) admitted to a German ICU between 2004 and 2009 were included. A follow-up of patients was performed retrospectively. The association of admission BT with both intra-ICU and long-term mortality was investigated by logistic regression. Results: Patients with hypothermia (<36°C BT) were clinically worse and had more pronounced signs of multi-organ failure. Admission BT was associated with adverse overall outcome, with a 2-fold increase for hyperthermia (mortality 12%; odds ratio [OR] 1.80, 95% confidence interval [CI] 1.43–2.26; p < 0.001), and a 4-fold increase for the risk of hypothermia (mortality 24%; OR 4.05, 95% CI 3.38–4.85; p < 0.001) with respect to intra-ICU and long-term mortality. Moreover, hypothermia was even more harmful than hyperthermia, and both were strongly associated with intra-ICU mortality, especially in patients admitted with acute coronary syndrome (hypothermia: hazard ratio 6.12, 95% CI 4.12–9.11; p < 0.001; hyperthermia: OR 2.70, 95% CI 1.52–4.79; p< 0.001). Conclusion: Admission BT is an independent risk predictor for both overall intra-ICU and long-term mortality in critically ill patients admitted to an ICU. Therefore, BT at admission might not only serve as a parameter for individual risk stratification but can also influence individual therapeutic decision-making.

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Is body temperature an independent predictor of mortality in hip fracture patients?

Cited by 13 publications

References 21 publications

Individual differences in normal body temperature: longitudinal big data analysis of patient records

Individual differences in normal body temperature: longitudinal big data analysis of patient records

Too Cool? Hip Fracture Care and Maintaining Body Temperature

Admission Body Temperature in Critically Ill Patients as an Independent Risk Predictor for Overall Outcome

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