• L Leibovici, A Gafter-Gvili, M Paul, N Almanasreh, E Tacconelli, S Andreassen, A D Nielsen, U Frank, R Cauda, and TREAT Study Group.
• Department of Medicine E, Rabin Medical Center, Beilinson Campus, and Sackler Faculty of Medicine, Petah-Tiqva 49100, Tel-Aviv University, Israel. leibovic@post.tau.ac.il
• QJM. 2007 Oct 1;100(10):629-34.

BackgroundExcess activation of the sympathetic nervous system may be a risk factor for mortality in patients with the systemic inflammatory response syndrome (SIRS) or sepsis.AimTo examine whether excessive tachycardia, relative to the degree of fever is an independent risk factor for death in patients with SIRS.DesignProspective observational study.SettingDepartments of medicine in three university hospitals in Israel, Germany and Italy.MethodsWe collected data for 3382 patients with SIRS, whether community- or hospital-acquired, 91% with sepsis, as part of an ongoing trial.ResultsOverall 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.DiscussionOur 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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