Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
Daniel Thomas‐Rüddel, Peter Hoffmann, Daniel Schwarzkopf, Christian Scheer, Friedhelm Bach, Marcus Komann, Herwig Gerlach, Manfred Weiß, Matthias Lindner, Hendrik Rüddel, Philipp Simon, Sven‐Olaf Kuhn, Reinhard Wetzker, Michael Bauer, Konrad Reinhart, Frank Bloos, the MEDUSA study group, Gernot Marx, Achim W. Schindler, Tobias Schürholz, Heike Schlegel‐Höfner, Günther Lehmann, Annett Sander, Steffen Friese, Christian W. Scholz, Pia Fischer, Christina Fuchs, Lutz Becher, Norbert Salewsky, Torsten Schreiber, Anton Goldmann, Didier Keh, Katrin Schmid, Winfried Menning, Renate Steuckart, Robert Barz, Karin Dey, Meike Fahrenholz, Martin Müller, Herwig Gerlach, Susanne Toussaint, Jörg Brederlau, Friedhelm Bach, Dirk Buschmann, Ingo Gummelt, J. Hoeschen, Marion Klaproth, Ina Vedder, Ulrike Bachmann‐Holdau, Jürgen Eiche, Rolf Hauschild, Martina Lange, Davia Herrmann‐Karbaum, Annette Lubasch, Marcus Rücker, Christian Icke, Alexander Lücht, Andreas Meier‐Hellmann, Jan Wagner, Olaf Arnold, Steffen Kästner, Tobias Clausen, Michael Sternkopf, Robert Voswinckel, T. Benndorf, Christel Eiserloh, Gerhard Kuhnle, Mathias Koch, Manuela Gerber, Matthias Gründling, Liane Guderian, Sven-Olaf Kuhn, Christian Scheer, Gerd Scheiber, Frank Bloos, Susann Christink, Martina Kortegast, Claudia Matthäus‐Krämer, Marcel Mücke, Bernhard Poidinger, Hendrik Rüddel, Ulrike Redlich, Daniel Schwarzkopf, Daniel Thomas‐Rüddel, Christel Volkmer, Stefanie D’Aria, Thees Lemke, Birgit Michaelsen, Dirk Schädler, Nina Schulz‐Ruhtenberg, Norbert Weiler, Martin Anetseder, Zoran Textor, Udo X. Kaisers, Philipp Simon, Georg Braun, Nicole Jensen, Werner Gegenfurtner, Alexander Meinhardt, Robert Schmitt
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.