Fig. 3 Flow chartsof patients included in analyses
ANZ data
405,359 patientsincluded in the database
from 2005-2009
14,162 (3·5%) no APACHE III diagnostic code available
17,553 (4·3%) no vital status at discharge available
32,921 (8·1%) no APACHE III risk of death data available
65,061 (16·1%) no temperature data available
6,584 (1·6%) with admission on diagnosis of cardiac arrest
269,078 (66·4%)
eligible for
study inclusion
29,083[KR1] (10·8%) with infection admission diagnosis / 239,995 (89·2%) with non-infection admission diagnosis
UK data
399,827 patientsincluded in the database
from 2005-2009
96 (0·02%) no primary reason for admission recorded
4,826 (1·2%) no vital status at ultimate discharge from acute hospital available
145 (0·04%) no ICNARC model risk of death data available
5,400 (1·4%) no temperature data available
22,387 (5·6%) with CPR within 24 hours prior to admission
366,973 (91·8%) eligible for study inclusion
103191 (28·1%) with infection admission diagnosis / 263782 (71·9%) with non-infection admission diagnosis
Table 4 ANZICS APACHE codes allocated to the infection group for the ANZ data
Code / Diagnosis / Number / Number (%)
205, 210, 212, 213 / Pneumonia / 10070/29083 (34·6%)
404 / CNS infection / 1067/29083 (3·7%)
501, 502, 503, 504 / Sepsis / 14305/29083 (49·2%)
1102, 1904 / Cellulitis and localised soft tissue infections / 968/29083 (3·3%)
1406 / Cholecystitis / cholangitis / 2673/29083 (9·2%)
Table 5 ANZICS APACHE codes allocated to the non infection group for the ANZ data
Code / Category / Number / Number (%)
101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111 / Cardiovascular (medical) / 14899/239995 (6·2%)
201,202, 203, 204, 206, 207, 208, 209, 211 / Respiratory (medical) / 20658/239995 (8·6%)
301, 302, 303, 304, 305, 306, 307, 308, 309, 310, 311, 312, 313 / Gastrointestinal (medical) / 10476/239995 (4·7%)
401, 402, 403, 405, 406, 407, 408, 409, 410 / Neurological (medial) / 13141/239995 (5·5%)
601, 602, 603, 604, 605 / Trauma (without surgery) / 11857/239995 (4·9%)
701, 702, 703, 704 / Endocrine (medical) / 16035/239995 (6·7%)
801, 802 / Hematological / 1302/239995 (0·5%)
901 / Genitourinary / 3723/239995 (1·6%)
902 / Pre-eclampsia/ eclampsia / 326/239995 (0·1%)
903 / Hemorrhage, postpartum / 326/239995 (0·1%)
1002 / Other medical disorders : nos / 43/239995 (0·01%)
1101 / Rheumatological / 243/239995 (0·1%)
1201, 1202, 1203, 1204, 1205, 1206, 1207, 1208, 1209, 1210, 1211, 1212, 1213 / Cardiovascular surgery / 54609/239995 (22·7%)
1301, 1302 / Thoracic surgery / 4306/239995 (1·8%)
1303, 1304 / ENT surgery / 7080/239995 (3·0%)
1401, 1401, 1402, 1403, 1404, 1405, 1407, 1408, 1409, 1410, 1411, 1412, 1413 / Gastrointestinal surgery / 35543/239995 (14·8%)
1501, 1502, 1503, 1504, 1505, 1506 / Neurological / spinal surgery / 16363/239995 (6·8%)
1601, 1602, 1603, 1604, 1605 / Trauma (requiring surgery) / 5337/239995 (2·2%)
1701, 1703, 1704, 1705 / Urological surgery / 6700/239995 (2·8%)
1801, 1802, 1803 / Gynaecological surgery / 3834/239995 (1·6%)
1901, 1902 / Orthopaedic surgery / 9899/239995 (4·1%)
1903 / Cosmetic and skin surgery / 1298/239995 (0·5%)
2101 / Hematologic surgery / 127/239995 (0·05%)
2201 / Endocrine surgery / 1870/239995 (0·8%)
Table 6 Additional baseline characteristics and physiological data for study patients
ANZ cohort / UK cohort
Infection
(n=29,083) / Non-infection
(n=239,995) / Infection (n=103191) / Non-infection
(n=263782)
Co morbidities
[number (%)]
Cancer / 2,602 (9) / 10,181 (4) / 4968 (5) / 9063 (3)
Immunosuppression by disease or treatment / 2,879 (10) / 6,885 (3) / 7122 (7) / 13471 (5)
Chronic respiratory disease / 3,245 (11) / 17,797 (7) / 3645 (4) / 7318 (3)
Chronic cardiovascular disease / 3,769 (13) / 29,771 (12) / 1685 (2) / 4408 (2)
Chronic liver disease / 749 (3) / 3,537 (1) / 1665 (2) / 6355 (2)
Chronic renal disease / 1,701 (6) / 6,683 (3) / 1814 (2) / 3508 (1)
Physiological variables from the first 24 hours in ICU
Lowest temperature [mean (SD)] / 36.2 (1.0) / 35.9 (0.9) / 36.0 (1.0) / 35.9 (1.0)
Lowest MAPa [median [IQR]] / 65 [58-73] / 68 [61-77] / 63 [55-71] / 67 [58-75]
Lowest heart rate [mean (SD)] / 77·4 (19·1) / 70·2 (16·6) / 79·4 (18·9) / 71·7 (17·7)
Lowest respiratory rate [mean (SD)] / 15·3 (5·4) / 12·53 (4·2) / 13·7 (5·6) / 12·3 (4·1)
P value for all comparisons <0·0001 between infection and non-infection subgroups
aMAP: mean arterial pressure
Table 7 In-hospital mortality relative to normothermia (36·5-36·9oC) in non infection patients with neurologically injured patients excludedANZ cohort
Temperature
(oC) / Number in category / In-hospital mortality
No. (%) / Odds ratio for in-hospital mortality
(±95% CI) / Adjusted* odds ratio for in-hospital mortality
(±95% CI)
<36 / 3147 / 1069 (34) / 6·50 (5·98-7·05) / 3·51 (3·15-3·91)
36-36·4 / 15966 / 1701 (10·7) / 1·51 (1·42-1·60) / 1·34 (1·24-1·44)
36·5-36·9 / 43974 / 3227 (7·3) / 1 / 1
37-37·4 / 63592 / 4242 (6·7) / 0·90 (0·86-0·95) / 0·85 (0·81-0·90)
37·5-37·9 / 43455 / 2958 (6·8) / 0·92 (0·88-0·97) / 0·79 (0·74-0·84)
38-38·4 / 21770 / 1839 (8·4) / 1·17 (1·10-1·24) / 0·84 (0·78-0·90)
38·5-38·9 / 8595 / 898 (10·4) / 1·47 (1·36-1·59) / 0·84 (0·77-0·92)
39-39·4 / 3073 / 478 (15·6) / 2·33 (2·10-2·58) / 1·07 (0·95-1·21)
39·5-39·9 / 994 / 186 (18·7) / 2·91 (2·47-3·42) / 1·02 (0·84-1·24)
≥40 / 440 / 160 (36·4) / 7·23 (5·93-8·81) / 1·84 (1·45-2·34)
UK cohort
Temperature
(oC) / Number in category / In-hospital mortality
No. (%) / Odds ratio for in-hospital mortality
(±95% CI) / Adjusted+ odds ratio for in-hospital mortality
(±95% CI)
<36 / 6120 / 3085 (50·4) / 4·47 (4·09-4·88) / 2·78 (2·56-3·02)
36-36·4 / 17914 / 4484 (25·0) / 1·47 (1·39-1·55) / 1·31 (1·23-1·39)
36·5-36·9 / 44682 / 8285 (18·5) / 1 / 1
37-37·4 / 63331 / 10039 (15·9) / 0·83 (0·80-0·86) / 0·86 (0·83-0·90)
37·5-37·9 / 49915 / 7258 (14·5) / 0·75 (0·71-0·79) / 0·77 (0·74-0·81)
38-38·4 / 27019 / 4171 (15·4) / 0·80 (0·75-0·86) / 0·77 (0·73-0·82)
38·5-38·9 / 10816 / 1997 (18·5) / 0·99 (0·92-1·08) / 0·83 (0·77-0·90)
39-39·4 / 4021 / 927 (23·1) / 1·32 (1·18-1·46) / 0·97 (0·88-1·08)
39·5-39·9 / 1339 / 370 (27·6) / 1·68 (1·47-1·92) / 1·00 (0·86-1·17)
≥40 / 667 / 278 (41·7) / 3·14 (2·63-3·75) / 1·57 (1·27-1·95)
* Odds ratios adjusted for illness severity using APACHE III predicted log odds of risk of death with the temperature component removed
+ Odds ratios adjusted for illness severity using ICNARC (2009) model predicted log odds of acute hospital mortality with temperature component removed
[KR1]Add percentage here and the other three similar boxes ANZ and UK...