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Chin J Integr Med. 2014 Sep 24. [Epub ahead of print]

Cool extremities, a diagnostic sign recorded in Shang Han Lun, still good prognosis index for septic patients in today's medical intensive care unit.

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Department of Internal Medicine, Nantou Hospital, Department of Health, Executive Yuan, Nantou, Taiwan, 54044, China.



To evaluate and compare the predictive value of the physical signs mentioned by ZHANG Zhong-jing in Treatise on Cold Damaged Diseases (Shang Han Lun), together with other clinically determined diagnostic scores and laboratory values in modern medicine on 28-day mortality in septic patients.


Three-year prospective observation was conducted in medical intensive care unit in two local community hospitals. In all, 126 patients with severe sepsis and/or septic shock were consecutively enrolled. Ten diagnostic signs (lack of fever, lethargy, delirium, clammy skin, mottled skin, edematous limbs, cool extremities, threadlike pulse, tachycardia, and abdominal distension), acute physiology and chronic health evaluation (APACHE) II, cardiovascular component (CV score) in multiple organ dysfunction syndrome (MODS) score and blood sampled for cytokine measurement, including tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8, IL-10 and IL-18, were collected within 24 h after admission. Main outcome was 28-day mortality; independent predictors were determined by multivariate logistic regression analysis.


Significant correlation between lack of fever, cool extremities, abdominal distension, plasma IL-10 level and mortality emerged. Areas under the receiver operating characteristic curves for cool extremities (0.73, 95% confidence interval: 0.64-0.82, P<0.01) and IL-10 (0.74, 95% confidence interval: 0.66-0.83, P<0.01) indicated comparable discrimination between survivors and non-survivors.


Assessment of cool extremities in septic patients, which showed comparable discriminant ability as IL-10, proves prognostic value of diagnostic signs recorded in Treatise on Cold Damaged Diseases, and may provide a quicker, easily-observed, and non-invasive predictor of sepsis mortality.


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