Abstract
Background
The circadian rhythm is believed to offer survival advantage with dysregulation being linked to immune response deficiencies and metabolic derangements. Diurnal temperature variation exists in humans, yet its preservation during illness is not well understood. Herein we present an analysis of diurnal body temperatures among hospitalized patients, with a focus on infectious versus non-infectious diagnoses.
Methods
Temperatures measured within 1/2 hour of 8am, 12pm, 4pm, 8pm, 12 am, and 4am from 16,245 hospitalized patients were analyzed using descriptive statistics and t-tests.
Results
Although we found a diurnal pattern when analyzing the ensemble of temperatures from all patients (Figure 1), stratified by measurement site (oral, axillary, temporal, and tympanic), the through-to-peak difference was only 0.2F (0.1C), while previously reported diurnal difference in healthy volunteers was 1.9 °F (1.06 °C). Data from the core body temperature sites monotherm and rectal did not show any diurnal pattern. The peaks in body temperature occurred at 8 pm for all patients, regardless of age, which is similar to healthy people. However, the minimum body temperature was shifted to later times compared with healthy people (6am or 2 hours before rising in health) – for young patients (age 20-30 years, N=1285) the through was at 8am and for elderly patients (age 70-80 years, N=1736), it was at 12pm (Figure 2). Analysis of body temperature of individual patients showed that less than 20% of patients exhibited diurnal variation and among those showing variation, the trend was present only on the minority of hospitalization days (Table 1). Interestingly, the presence or absence of an infectious process did not influence the proportion of patients showing diurnal variation.
Figure 1
Figure 2
Table 1
Conclusion
Hospitalization is associated with disruption in the circadian rhythm as reflected by patients’ body temperature, with shifting of the diurnal variation curve and blunting of the temperature range both in the ensemble and on the individual level. The trend is not influenced by having an infection. However, since core body temperatures tend to be the measurement site of choice in the ICU setting, we suspect that further obliteration of the diurnal rhythm occurs with more severe disease.
Disclosures
All Authors: No reported disclosures
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