Background: Excess activation of the sympathetic nervous system may be a risk factor for mortality in patients with the systemic inflammatory response syndrome (SIRS) or sepsis. Aim: To examine whether excessive tachycardia, relative to the degree of fever is an independent risk factor for death in patients with SIRS. Design: Prospective observational study. Setting: Departments of medicine in three university hospitals in Israel, Germany and Italy. Methods: We collected data for 3382 patients with SIRS, whether community- or hospital-acquired, 91% with sepsis, as part of an ongoing trial. Results: Overall 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/℃ (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. Discussion: Our 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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