Impact of body temperature on in-hospital and long-term mortality in patients with acute heart failure

OBJECTIVES: Body temperature (BT) was shown to have impact on outcome in several medical conditions. This study investigated the prognostic impact of BT in patients with acute heart failure (HF). DESIGN AND PATIENTS: The B-type natriuretic peptide for Acute Shortness of breath EvaLuation (BASEL) study prospectively enrolled 452 consecutive patients presenting with acute dyspnoea to the emergency department. Among these, 170 patients had a final discharge diagnosis of acute HF and a documented BT on presentation. The primary endpoint was cardiovascular mortality during long-term follow-up. Morbidity was documented as secondary endpoint. RESULTS: BT on presentation was 37.2 degrees C (SD 0.9) and ranged from 34.8-40.4 degrees C. Patients were divided into quartiles of BT. Initial morbidity as reflected by intensive care unit admission rate was significantly higher among patients in the highest quartile (38% versus 13% in the first quartile, p <0.05). Length of stay in hospital was significantly increased by 2.7 days per one degree rise in BT. A total of 64 cardiovascular deaths occurred (38%). Kaplan-Meier analysis showed no apparent difference in long-term cardiovascular mortality among quartiles of BT. Cardiovascular mortality rate was 47% in the first (<36.6 degrees C), 26% in the second (36.7-37.2 degrees C), 44% in the third (37.3-37.8 degrees C) and 35% in the fourth quartile ( 37.9 degrees C; P = 0.31) at 720 days. In addition, Cox regression analysis adjusted for age and sex showed no association between BT and either in-hospital (HR 0.59, 95% CI 0.26-1.35; P = 0.21) or long-term cardiovascular mortality (HR 0.91, 95% CI 0.67-1.24; P = 0.55). CONCLUSION: In patients with acute HF, BT on presentation is not associated with in-hospital or long-term cardiovascular mortality, but is associated with short-term morbidity. However, it is important to stress that our findings relate to central BT and do not negate the undisputed value of assessing peripheral BT, which reflects peripheral hypoperfusion.