Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature

Abstract

Background Fever and hypothermia have been observed in septic patients. Their influence on prognosis is subject to ongoing debates. Methods We did a secondary analysis of a large clinical dataset from a quality improvement trial. A binary logistic regression model was calculated to assess the association of the thermal response with outcome and a multinomial regression model to assess factors associated with fever or hypothermia. Results With 6542 analyzable cases we observed a bimodal temperature response characterized by fever or hypothermia, normothermia was rare. Hypothermia and high fever were both associated with higher lactate values. Hypothermia was associated with higher mortality, but this association was reduced after adjustment for other risk factors. Age, community-acquired sepsis, lower BMI and lower outside temperatures were associated with hypothermia while bacteremia and higher procalcitonin values were associated with high fever. Conclusions Septic patients show either a hypothermic or a fever response. Whether hypothermia is a maladaptive response, as indicated by the higher mortality in hypothermic patients, or an adaptive response in patients with limited metabolic reserves under colder environmental conditions, remains an open question. Trial registration The original trial whose dataset was analyzed was registered at ClinicalTrials.gov (NCT01187134) on August 23, 2010, the first patient was included on July 1, 2011.

Development and validation of a predictive model for in-hospital mortality in patients with sepsis-associated liver injury

“…In infectious diseases, endogenous and exogenous heat sources lead to an increased body temperature, which is the response of the body against exogenous microorganisms ( 34 ). It has also been found that hypothermia increases the occurrence of adverse outcomes in septic patients, which is consistent with our findings ( 35 ).…”

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“… 8 , 9 In the real world, afebrile bacteraemia was often observed in immunocompromised individuals, 6 and the first-line physician frequently reported the episodes of hypothermia in critically ill patients. 10 Although numerous studies have previously reported that initial hypothermia or afebrile status results in unfavourable outcomes in patients experiencing sepsis or bacteraemia, 6 , 11 the evidence is limited regarding the comparisons of the prognostic effect of delayed AAT between bacteraemia patients with initial presentation of hypothermia, normothermia, and high febrile status. We hypothesised that the prognostic impact of delayed AAT differed in bacteraemia patients presenting with different iBTs.…”

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“…The predominance of either excessive pro-inflammatory responses or immunosuppression in sepsis also seems to be associated with two opposing states of thermoregulation. In a recent study, Thomas-Rüddel et al determined two subsets of septic patients, one with pronounced fever and another with hypothermia [ 28 ]. These phenotypes where associated with environmental temperature lending support to our assumption of a link between energy expenditure and resistance or disease tolerance, respectively [ 29 ].…”