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Van Dissel JT, Numan SC, van't Wout JW (Leiden University Medical Center and Bronovo Hospital, The Hague, The Netherlands). Chills in‘early sepsis’: good for you? (Rapid Communication)J Intern Med2005;257:469–472.We evaluated the predictive value of chills, bacteraemia and endotoxaemia for in-hospital mortality and survival at 5–10 years long-term follow-up in a prospective cohort of‘early sepsis’ patients presenting with fever resulting from community-acquired pneumonia or pyelonephritis. Febrile patients with chills had bacteraemia more often (RR 3.1, 95% CI 1.8–5.4) than those without chills. Neither chills nor bacteraemia were significantly related to in-hospital mortality, but patients with endotoxaemia had a higher in-hospital mortality rate than those without endotoxaemia. Patients with chills had a significantly higher survival rate at long-term follow-up than those without chills on admission: the estimated risk of dying was 0.644 (95% CI 0.43–0.95,P = 0.029) for an individual with chills, compared to a person without chills, adjusting for the other factors [age cohort, underlying disease and the pro-inflammatory response in the blood, i.e. tumour necrosis factor-α (TNF-α) and blood leucocyte number, as scored on hospital admission] in the Cox proportional hazards model. Chills may characterize a patient subpopulation that upon pulmonary and urinary tract infection is able to raise a more rapid and/or efficient host response. [ABSTRACT FROM AUTHOR] |
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