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Critical Care
Published in: Critical Care 1/2021

01-12-2021 | Septicemia | Research

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

Authors: Daniel O. 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

Published in: Critical Care | Issue 1/2021

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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.
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Metadata
Title
Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature
Authors
Daniel O. 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
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-021-03776-2

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