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

Critical Care

the MEDUSA study group¹  Daniel O. Thomas-Rüddel²  Konrad Reinhart²  Hendrik Rüddel²  Frank Bloos²  Michael Bauer²  Daniel Schwarzkopf²  Friedhelm Bach³  Sven-Olaf Kuhn⁴  Christian Scheer⁴  Marcus Komann⁵  Reinhard Wetzker⁵  Philipp Simon⁶  Manfred Weiss⁷  Matthias Lindner⁸  Herwig Gerlach⁹  Peter Hoffmann^1,10 

[1] ;Center for Sepsis Control and Care, Jena University Hospital;Department of Anesthesiology and Intensive Care Medicine, Evangelisches Klinikum Bethel;Department of Anesthesiology and Intensive Care Medicine, Greifswald University Hospital;Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital;Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital;Department of Anesthesiology and Intensive Care Medicine, Ulm University Hospital;Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein;Department of Anesthesiology and Intensive Care Medicine, Vivantes Klinikum Neuköln;Potsdam Institute for Climate Impact Research;

关键词: Fever;    Sepsis;    Outcome;    Mortality;    Body temperature;    PCT;   

DOI  :  10.1186/s13054-021-03776-2

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown